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IN THE MATTER OF THE APPLICATION OF SUPERIOR (The Superior Court of California - County of Orange)

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Page 1 of 2
PROOF OF SERVICE
PETITION FOR REHABILITATION AND PARDON
Optional Use
Form: L-0801 [Rev. March 24, 2011]
Penal Code, §§ 4852.01
and 4852.06
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
Telephone No.: Fax No. (Optional):
E-Mail Address (Optional):
ATTORNEY FOR (Name): Bar No:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER
700 CIVIC CENTER DRIVE WEST
POST OFFICE BOX 22024
SANTA ANA, CA 92702-2024
IN THE MATTER OF THE APPLICATION OF
_______________________________________
Petitioner's full name - First, Middle, Last
PROOF OF SERVICE
Petition for Certificate of Rehabilitation and Pardon
CASE NUMBER:
M -
TO BE COMPLETED BY THE PERSON SERVING.
THE PERSON SERVING MUST NOT BE THE PETITIONER.
(This is a two-page form - Complete both pages)
Check all applicable boxes:
I am over the age of 18 years and am not a party to the within action.
My Name
My Address
I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the
Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:
GOVERNOR OF THE STATE OF CALIFORNIA
DEPARTMENT OF LEGAL AFFAIRS
STATE CAPITOL BUILDING
1303 10TH ST
SACRAMENTO CA 95814-4910
By Personal Service:
On _________________ (date), I personally delivered a copy of the Notice, Petition and
attachments to the address above. The name of the person who received the copies is
___________________________.
OR
By Mail:
On _________________ (date), I personally mailed a copy of the Notice, Petition and
attachments to the address above, by placing it in a sealed envelope with postage thereon
fully prepaid into the United States mail at _________________ (place of mailing).
My Address
Name: Case Number: M-
Page 2 of 2
PROOF OF SERVICE
PETITION FOR REHABILITATION AND PARDON
Optional Use
Form: L-0801 [Rev. March 24, 2011]
Penal Code, §§ 4852.01
and 4852.06
I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the
Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:
ORANGE COUNTY DISTRICT ATTORNEY
401 CIVIC CENTER DRIVE WEST
SANTA ANA, CA 92701
By Personal Service:
On _________________ (date), I personally delivered a copy of the Notice, Petition and
attachments to the address above. The name of the person who received the copies is
___________________________.
OR
By Mail:
On
_________________ (date), I personally mailed a copy of the Notice, Petition and
attachments to the address above, by placing it in a sealed envelope with postage thereon
fully prepaid into the United States mail at _________________ (place of mailing).
I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the
Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:
____________________ COUNTY DISTRICT ATTORNEY
(ADDRESS)
_____________________________________
(ADDRESS) _____________________________________
By Personal Service:
On
_________________ (date), I personally delivered a copy of the Notice, Petition and
attachments to the address above. The name of the person who received the copies is
___________________________.
OR
By Mail:
On
_________________ (date), I personally mailed a copy of the Notice, Petition and
attachments to the address above, by placing it in a sealed envelope with postage thereon
fully prepaid into the United States mail at _________________ (place of mailing).
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
Date: _______________
(TYPE OR PRINT NAME OF PERSON WHO SERVED THE PAPERS) (SIGNATURE OF PERSON SERVING)
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IN THE MATTER OF THE APPLICATION OF SUPERIOR (The Superior Court of California - County of Orange)

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Completed 8 February 2021

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