CERTIFICATE OF REHABILIATION
Form: L-410.2 [Rev. July 15, 2011]
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 and Suffix, if applicable
Date of Birth:
CII Number:
Criminal Case Number(s): ____________________________________________
CERTIFICATE OF REHABILITATION
(Penal Code § 4852.13)
Type Applicant’s Full Name - First Middle Last and Suffix, if applicable
Type Applicant's Street Address, City, State, and ZIP Code
a Certificate of Rehabilitation pursuant to the provisions of Chapter 3.5, Title 6 of Part 3 of the Penal Code
of the State of California, was heard on
and proof having been made to the satisfaction of the Court that notice of the time of hearing has been regularly given as
required by law; and from satisfactory proof taken at said hearing the Court finds that all allegations of said petition are true,
and that the required period of rehabilitation has elapsed since petitioner's date of discharge from custody due to completion of
the term to which the petitioner was sentenced, or upon the release on parole or probation on
, that, where appropriate, petitioner has obtained relief pursuant to Penal
Penal Code section 1203.4, and that petitioner has demonstrated by the course of conduct his/her rehabilitation and fitness to
exercise all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15); and that the
time(s) convicted of a felony;
Total Number of Felony Convictions
The Certificate of Rehabilitation is granted. This Court declares the petitioner has been rehabilitated and is fit to exercise
all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15), and this Court recommends
that the Governor of the State of California grant a full pardon to said petitioner.
Dated:
Judicial Officer - TYPED or PRINTED
Judicial Officer - SIGNATURE
This form was prepared under the direction of the Office of the Attorney General of the State of California
