PETITION AND ORDER TO REDUCE OR VACATE CIVIL ASSESSMENT
PETITION AND ORDER FOR ABILITY TO PAY DETERMINATION
INFORMATION
If you submit the petition, the court will respond to you in writing. Please allow up to four weeks for a response.
If the court requires more information to make its determination, you will be notified in writing. The court may also order
you to appear in court for a hearing.
For Petition to Reduce or Vacate Civil Assessment:
Provide the reason(s) and documentation for your failure to appear on the due date.
For Petition for Ability-to-Pay Determination:
Provide the reason(s) and any documentation to support your request, such as:
Proof of receiving any supportive services, such as food stamps, IHSS, general relief, etc.
Any recent statements for fixed monthly payments (car, rent, utilities, credit card/loans, etc.)
Pay stubs, disability/retirement income, or any other source of income
Bank statements, W-2’s, bankruptcy information and/or income tax returns
IMPORTANT: Once the judicial officer has made a ruling, the court will discard all supportive documents submitted with this
petition. To have your documents returned, provide a self-addressed stamped envelope with the proper postage attached.
The Court has reviewed and considered the:
☐ Petition to Reduce or Vacate Civil Assessment:
The court ☐ does ☐ does not find good cause for the failure to appear.
☐ Petition for Ability-to-Pay Determination
The Court Now Orders:
☐ Good cause shown, the civil assessment is reduced to $ ________________. ☐ Civil assessment is vacated.
☐ Collection vendor/court staff to set up a payment plan with the defendant.
☐ It is determined that the defendant’s ability to pay is $ _______________. Due by _____________________.
As to count(s): 1. _____________ 2. _____________ 3. ______________ 4. ______________ 5. _____________.
☐ Driver’s license hold released for this citation.
☐ Sentence suspended. ☐ As to counts: __________________________________________________ ☐ All counts.
☐ Petition is denied. All previous orders remain in full force and effect. ☐ No further proceedings on this issue.
☐ Matter is ordered set for an ability-to-pay hearing. Defendant ordered to appear as directed and bring the following:
____________________________________________________________________________________________________
☐ ____________________________________________________________________________________________________
____________________________________________________________________________________________________
For Court Use
Ability-to-Pay Hearing: Your court hearing has been set as follows:
PROOF OF SERVICE
I, the below-named Executive Officer/Clerk of the above entitled court, do hereby certify that I am not a party to the cause herein,
and that on this date, I served the Petition and Order upon the defendant/counsel as indicated on Page One of this document: ☐
by placing it for collection and mailing so as to cause it to be deposited in the United States mail at the courthouse in
____________________________________, California. One copy of the original filed in a sealed envelope to the address of record
with the postage thereon fully prepaid, in accordance with court practices. ☐ by personally providing a copy to the defendant.
SHERRI R. CARTER, Executive Officer/Clerk
SCAN THIS FORM AS: ☐ PETG (Granted) ☐ PETD (Denied) ☐ PETH (Hearing Set)
