SUPERIOR COURT OF CALIFORNIA
COUNTY OF SOLANO
CRIMINAL/TRAFFIC DIVISION
Fairfield Branch Vallejo Branch
600 Union Avenue 321 Tuolumne Street
Fairfield, CA 94533 Vallejo, CA 94590
(707) 207-7360 (707) 561-7860
DECLARATION FORM INSTRUCTIONS
(For Submission, Modification, or Reconsideration)
A separate declaration must be completed for each case.
Current address and telephone number are required. This
information will be used to notify you of the Judge’s decision
concerning your case.
Mark the box or boxes which best describes what you are
requesting of the Court. If you are requesting a lower fine, an
extension to pay, a payment plan, dismissal of charge(s) or late
fees, or community service, you are requested to provide current
proof of income or other means of financial support. Examples of
supporting documentation may include, but is not limited to,
evidence of public benefits or government assistance, evidence of
monthly income, and/or evidence of disability.
Inability to Pay: To ask the court to consider your ability to pay
due to financial hardship and to decide whether to approve a lower
fine, a payment plan or community service, you may be scheduled
for an appearance in court without deposit of bail
If you are requesting credit for time served, please submit a
booking summary or court order that outlines the location and
amount of time served.
If you are asking the Court to dismiss late fees for Failure to
Appear, Failure to Pay, or the $300 Civil Assessment, be sure to
give the reason(s) for your failure to appear/pay. Please note
that applicable proof must be attached and coincide with the
time period in question.
If you are a full-time student, a copy of your class schedule is also
required.
A plea of guilty/not guilty must be entered for all charges. If it is
your intent to plead guilty, please date and sign the Entry of Plea
and Waiver of Rights Declaration Form attached.
Sign and date your declaration.
Faxed Declarations will not be accepted.
SUPERIOR COURT OF CALIFORNIA 4809-TR
COUNTY OF SOLANO
CRIMINAL/TRAFFIC DIVISION
[ ] Hall of Justice [ ] Solano Justice Center
600 Union Avenue 321 Tuolumne Street
P.O. Box 2463 Vallejo, CA 94590
Fairfield, CA 94533 (707) 561-7860
(707) 207-7360
Mandatory Form
4809-TR
DECLARATION TO DISMISS CIVIL
ASSESSMENT / ABILITY TO PAY FORM
Page 1 of 2
DECLARATION TO DISMISS CIVIL ASSESSMENT /
ABILITY TO PAY FORM
Case Number:
If you have more than one case, use one form for each case.
1. Your Information
Name:
Street or Mailing Address:
City: State: Zip:
Tel.: Date of Birth:
E-mail (optional):
GC Clerk fills out this box
FTA
FTP
A Traffic School Certificate was filed.
$
Amount ordered Due date
$
Amount paid Date paid
Balance due: $
2.
What kind of help do you want from the court?
(Check all that apply to your request.)
1. Lower the fine 4. Payment plan 8. Release DMV License Hold (Abstract)
2. Extend deadline to pay 5. Dismiss the fine/charge 9. Accept Proof of Correction
3. Credit for time served 6. Community Service 10. Dismiss late fee ($300 Civil Assessment)
in jail or residential 7. Ask for a Court Date 11. Other (specify):_______________________
treatment program
3.
I failed to appear or pay because one or more of the following reasons existed at the time I was
scheduled to appear or pay. (Check all that apply.)
Hospitalization Death of Immediate Family Member Could not afford to pay on due date
Physically Incapacitated In Jail or Residential Treatment Program
Military Absence Other (specify):
Important! Attach a copy of any document that proves you were unable to appear or pay when scheduled to do so.
Use the space in Item 8 to explain the reasons you checked for your failure to appear or pay.
4.
Can you afford to pay?
Yes (Skip Sections 5 and 6; Complete Sections 7, 8 and 9)
No (If you check this box, you must also fill out Sections 5, 6*, 7, 8 and 9.)
5. Public Benefits Check any benefits listed below that you are receiving now.
If you do not receive benefits, go to the next question.
Medi-Cal CalFresh/WIC CalWorks CAPI SSI/SSP Low-Income Veterans Pension
Tribal TANF Refugee Cash Assistance General Assistance Extended Foster Care IHSS
Other need-based help (specify):
Important! Attach a copy of any document that proves you are getting the benefits you checked.
6.
Homeless or Temporary Housing
If you are homeless, live in a shelter, or in a transitional living facility, check below.
Homeless (Where do you usually sleep?):
Shelter or Transitional living facility (Which one?):
Applicant’s Name:
Case Number:
Mandatory Form
4809-TR
DECLARATION TO DISMISS CIVIL
ASSESSMENT / ABILITY TO PAY FORM
Page 2 of 2
7. Household Income *(skip this section if you checked any public benefits in Item 4 or any box in Item 5)
Monthly income $______________________
Number of people in household: __________
Important! Attach a copy of any document(s) that proves the amount of gross-monthly income (before tax deductions)
for your household. In Item 8, provide any details or special circumstances you want the court to consider.
8. Describe your Request
Please explain the reason for your request and why you previously failed to appear or pay. Include any details or
special circumstances you want the court to consider. (Attach more pages if you need more space.)
9.
Read and sign below.
I declare under penalty of perjury under the laws of the State of the California that the information I have provided on
this form is true and correct.
Date:
Applicant signs here
Submitted by:
Clerk Name
For Court Use Only
Court’s Decision
[ ] Granted No (s). Deadline to Pay Extended: ____ 3 Months ____ 6 months
[ ] Denied No (s).
[ ] Fine reduced to:
[ ] Other Orders
Date:
JUDICIAL OFFICER/DIVISION MANAGER
FORM 4874-TR
PLEA FORM
Page 1 of 1
MANDATORY
Superior Court of California
Criminal/Traffic Division
Solano County
Case No.
Plea Form
(Infractions)
Fill out this form if:
You accept the charges on your infraction ticket,
You want to plead guilty or no contest in this case, and
You want to plead using this form instead of going to court.
1 Your Information
Name: Case Number:
Street or Mailing Address:
Tel.: Email (optional): Date of Birth:
2 Charges I am pleading guilty or no contest to the following traffic infraction(s):
Section and Code:
3 You have the following rights:
To have a lawyer represent you (at your expense).
To an interpreter if you do not speak English well.
To a speedy court trial within 45 days of your first court date. At that trial, you have the right to not testify
against yourself, to subpoena witnesses to testify for your case, and to see and question witnesses.
To appeal the court’s decision.
4 If you check Guilty or No contest below, that means:
You accept the charge(s) on the ticket.
There will not be a trial or witnesses.
You give up the rights explained on this form.
A “no contest” plea is basically the same as a “guilty” plea. It is a way of saying, “I don’t believe I did all that the
officer charges, but I admit violating the law.” This plea is traditionally used if there was an accident or other
reason you don’t want the plea to be used as an admission of liability in a civil case related to the incident.
5 Your Plea Check one: Guilty No Contest
I declare under penalty of perjury under the laws of the State of the California that there are facts to support my plea,
and that the information I have provided on this form is true and correct.
Date:
Sign here
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome