Attorney or Party Without Attorney (name & address)                                    Telephone Number
  Robert John Doe                                                             999) 555-6655
  7777 W. Freedom Street
  Los Angeles, California 90012-3710
Attorney for (name):  Robert John Doe

COURT OF CALIFORNIA, COUNTY OF  { Los Angeles County }

                                                                                                                                JUDICIAL DISTRICT
      STREET ADDRESS:  210 West Temple Street
     MAILING ADDRESS:
    CITY AND ZIP CODE:  Los Angeles, California, 90012-3710
           BRANCH NAME:   Clara Shortridge Foltz Criminal Justice Center

 FOR COURT USE ONLY
THE PEOPLE OF THE STATE OF CALIFORNIA

VS 		  CASE NUMBER  

  BA 300499-01


Robert John Doe		   HEARING DATE


 
Application to Withdraw Misdemeanor Conviction after One Year Without Probation, to Dismiss The Case, & for Relief From All Penalties & Disabilities Resulting From Offense
(Penal Code §1203.4a)		   DEPT.            TIME
 

  I, Your Full Name, the undersigned applicant declare:

1. I am the applicant in the above entitled criminal action.
2. On  March 22, 1983, I was convicted of the following misdemeanor offense  of Trespassing
3. I was not put on probation and I have fully complied with and performed the sentence of the court.
4. More than one year has passed since the date of pronouncement of judgment.
5. I am not now serving a sentence for any other criminal offense.
6. I am not now charged with the commission of any offense in any pending criminal case.
7. Since the date of pronouncement of judgment, I have lived an honest and upright life and have conformed to and obeyed the laws of the land.
 
  WHEREFORE,  applicant moves that:
1. [ X ]  The court allow me to withdraw my plea of guilty/nolo contender and to enter a plea of not guilty;
  [ X ] The court set aside and vacate the jury's verdict or the court finding of guilty after the trial of the above entitled action;
2. The court dismiss this action pursuant to Penal Code   §1203.4a.
3. The court order that I be released from all penalties and disabilities resulting from the conviction except as otherwise expressly provided by law.
  I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

 

DATED: ____________

 

APPLICANT: ___________________________

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