Fillable form if you have been granted a Certificate (California)

Fill Online, Printable, Fillable, Blank form if you have been granted a Certificate (California) Form

Use Fill to complete blank online CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

form if you have been granted a Certificate (California)

On average this form takes 8 minutes to complete

The form if you have been granted a Certificate (California) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

BROWSE CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Governor Gavin Newsom · State Capitol ·Sacramento, California 95814
APPLICATION FOR PARDON
Complete this application to request a gubernatorial (governor’s) pardon. This application is for a direct pardon; do not complete this
form if you have been granted a Certificate of Rehabilitation. If you have submitted a pardon application in the last three years or if
you have obtained a Certificate of Rehabilitation, please complete a re-application form. The Governor’s Office and/or the Board of
Parole Hearings may contact you for additional information relating to your application. If the Governor grants you a pardon, some
information from your application will appear in a public report about clemency submitted to the California Legislature each year.
Learn more about the pardon application process at www.gov.ca.gov/clemency or mail a request for information to: Office of the
Governor, State Capitol, Attn: Legal Affairs/Clemency, Sacramento, CA 95814.
APPLICANT INFORMATION
(Attach additional pages as necessary)
Name (Last/First/Middle):________________________________________________________________________________________
Date of Birth: ___________________________________ Social Security Number: __________________________________________
Residence Address: _____________________________________________________________________________________________
Mailing Address (if different): ____________________________________________________________________________________
Home/Cell Phone: _________________________ Work Phone: __________________________ Email: _________________________
1. Conviction Summary (Note: The Governor’s Office will review a complete copy of your criminal history report.)
Crime(s):
Date(s) of conviction:
County of conviction(s):
Sentence(s):
Were you under 26 years of age at the time of the crime(s) for which you are seeking a pardon? ☐YES ☐NO
Crime(s):
Date(s) of conviction:
Location of conviction(s):
Sentence(s):
Rev. 2019
Application for Gubernatorial Pardon, Page 1 of 2
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________
_________________________________________ ___________________________________________
2. Describe the circumstances of your crime(s).
3. Describe how a pardon may impact your life (e.g., immigration consequences, employment opportunities, impact on family
members, civic participation).
4. Describe your life since your conviction (e.g., efforts in self-development, including identifying and addressing treatment needs,
professional and educational achievement; any set-backs, arrests, and new convictions; insight about past conduct; and future
goals).
5. If you have paid any money or given any gift to anyone to assist you in preparing this application, you are required by law to list
their name, address, phone number, email address, the nature of your relationship, and amount paid or gift given.
APPLICANT DECLARATION
Complete the following statement after you have served your Notice of Intent to Apply for Clemency.
I, ___________________________________________, declare under penalty of perjury under the laws of the State of
(Print Applicant Full Name)
California that the information I have provided on this application is true and correct. I further declare that I have served (mailed or
delivered) my notice of intent to apply for clemency on the District Attorney of the County of ________________________________.
(Name of County or Counties)
Applicant Signature Date
Submit this completed 2-page form to the Office of the Governor, State Capitol, Attn: Legal Affairs/Clemency, Sacramento, CA 95814.
You may, but are not required to, include copies of relevant documents that support your application (e.g., certificates of achievement,
photographs, letters of support, etc.). Do not send original documents, as application documents cannot be returned. Please update
the Governor’s Office promptly if your contact information changes. Submit a completed Notice of Intent to Apply for Clemency to
the district attorney in the county of your convictions for which you are seeking a pardon.
Rev. 2019
Application for Gubernatorial Pardon, Page 2 of 2
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

form if you have been granted a Certificate (California)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 January 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document