NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-409 [Rev.July 15, 2011]
Penal Code, §§ 4852.07
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
T
elephone 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
________________________________________________________________
Type Petitioner’s full name First Middle Last and Suffix, if applicable
Date of Birth:
CII Number:
NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILITATION
AND PARDON
(Penal Code § 4852.07)
CASE NUMBER:
M -
To the Governor of the State of California:
To the District Attorney, County of ;
County of Petitioner’s Residence
To the District Attorney, County of ;
County of most recent qualifying conviction, if different from County of Residence
To the District Attorney, County of ;
County of 2nd most recent qualifying conviction, if applicable
To the District Attorney, County of ;
County of 3rd most recent qualifying conviction, if applicable
On _________________________ the undersigned has filed a petition in the above mentioned court for a
Date of Filing
Certificate of Rehabilitation and Pardon in accordance with the provision of Chapter 3.5, Title 6, Part 3 of the Penal
C
ode of the State of California.
T
he petition will be heard on _______________ at ___________ in Department __________ at the Superior Court
Date of Hearing
Time
Department
of
California, County of Orange, Central Justice Center.
Date
TYPE OR PRINT NAME OF PETITIONER