SUPERIOR COURT OF CALIFORNIA
COUNTY OF LOS ANGELES
Reserved for Clerk’s File Stamp
People of the State of California
DECLARATION RE: ABILITY TO PAY COSTS FOR
PETITION AND ORDER FOR EXPUNGEMENT PC§1203.4
I have the ability to pay the $ _________________ costs for services rendered
associated with ling my petition.
I do not have the ability to pay the costs of services rendered associated with ling
my petition and have completed the Defendant’s Statement of Assets (CR-115),
and/or Request to Waive Additional Court Fees (Superior Court)(FW-002).
I declare under penalty of perjury under the laws of the state of California that the
foregoing is true and correct.
Date Signature of Declarant
LASC CRIM 196 Rev. 06/18
For Optional Use
(Declaration Re: Costs)