Fillable SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES (LA Court)

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SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES (LA Court)

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SUPERIOR COURT OF CALIFORNIA
COUNTY OF LOS ANGELES
Reserved for Clerk’s File Stamp
COURTHOUSE ADDRESS:
PLAINTIFF:
People of the State of California
DEFENDANT:
DECLARATION RE: ABILITY TO PAY COSTS FOR
PETITION AND ORDER FOR EXPUNGEMENT PC§1203.4
CASE NUMBER
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
(PC§ 987.8(g)(2))
(Declaration Re: Costs)
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SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES (LA Court)

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Completed 27 August 2020

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