NDICA Intakes

Today's Date

Date

Case No.

Client's Legal Name

Client's Date of Birth

Date

Date of Conviction

Date

Reason for Expungement

Client's Street Address

123 Test Street

Client's City

Los Angeles

Client's State

e.g. CA

Client's Zip

Client's Telephone No.

(XXX)XXX-XXXX

Client's Email Address

Office - D.A or C.A./Prosecutor *

Court Selection *

1. Step 1: Please select whether this case is being handled by the District Attorney or City Attorney. If unknown, please select District Attorney.

2. Step 2: Please select the proper courthouse, if unknown, select unkown.

3. Step 3: After your selection, if available, select"Run Autofill." The proper court address will populate on the paperwork.

Address Tool

Superior Court of CA County

e.g County of Orange

CourtAddressLine1

Street Address

CourtAddressLine2

City, State Zip

ProsecutorsOffice

e.g Long Beach Prosecutor

ProsecutorsAddressLine1

Street Address

ProsecutorsAddressLine2

City, State Zip

Code

Section

Type of Offense

Eligible for 17(b) Reduct?

Eligible for 17(d)(2) Reduct?

Code

Section

Type of Offense

Eligible for 17(b) Reduct?

Eligible for 17(d)(2) Reduct?

Code

Section

Type of Offense

Eligible for 17(b) Reduct?

Eligible for 17(d)(2) Reduct?

Code

Section

Type of Offense

Eligible for 17(b) Reduct?

Eligible for 17(d)(2) Reduct?

Code

Section

Type of Offense

Eligible for 17(b) Reduct?

Eligible for 17(d)(2) Reduct?

2. Felony or misdemeanor with probation granted (Pen. Code, § 1203.4) .

Probation was granted on the terms and conditions stated in the docket of the above-entitled court; the petitioner is not serving a sentence for any offense, on probation for any offense, or under charge of commission of any crime, and the petitioner (check all that apply)

a. has fulfilled the conditions of probation for the entire period thereof b. has been discharged from probation prior to the temrination fo the period thereof c. should be granted relief in the interests of justice. Please note: You may explain why granting a dismissal would be in the interests of justice. You can provide that information in writing in the space below, or by attaching a letter or other relevant documents. If you need more space for your writing, you can use the Attached Declaration (form MC-031) and attach it to this petition.

3. Misdemeanor or infraction with sentence other than probation (Pen. Code, § 1203.4a)

Probation was not granted; more than one year has elapsed since the date of pronouncement of judgment. Petitioner has complied with the sentence of the court and is not serving a sentence for any offense or under charge of commission of any crime; and the petitioner (check one)

a. has lived an honest and upright life since pronouncement of judgment and conformed to and obeyed the laws of a. the land; or b. should be granted relief in the interests of justice. (Please note: You may explain why granting a dismissal would be in the interests of justice. You can provide that information by writing in the space below or by attaching a letter or other relevant documents. If you need more space for your writing, you can use the Attached Declaration (form MC-031) and attach it to this petition.

5.

Felony county jail sentence under Penal Code section 1170(h5) (Pen. Code, § 1203.41)

1. more than one year has elapsed since petitioner completed the felony county jail sentence with a period of a. mandatory supervision imposed under Penal Code section 1170(h5B); or b. more than two years have elapsed since petitioner completed the felony county jail sentence without a period of mandatory supervision imposed under Penal Code Section 1170(h)(5)(A) (Please note: You may explain why granting a dismissal would be in the interests of justice. You can provide that information by writing in the space below or by attaching a letter or other relevant documents. If you need more space for your writing, you can use the Attached Declaration (form MC-031) and attach it to this petition.)

6.

Felony prison sentence that would have been eligible for a felony county jail sentence after 2011 under Penal Code section 1170(h)(5) (Pen. Code, § 1203.42) (Please note: You may explain why granting a dismissal would be in the interests of justice. You can provide that information by writing in the space below or by attaching a letter or other relevant documents. If you need more space for your writing, you can use the Attached Declaration (form MC-031) and attach it to this petition.)

Deferred entry of judgment (Pen. Code, § 1203.43)

7. Petitioner performed satisfactorily during the period in which deferred entry of judgment was granted. The criminal were dismissed under former Penal Code Section 1000.3 on:

Dismissal Date

Date

a. court records are available showing the case resolution; or b. petitioner declares under penalty of perjury that the charges were dismissed after he or she completed the b. requirements for deferred entry of judgment. Petitioner (check one)

b

has attached a copy of his or her state summary criminal history information has not attached a copy of his or her state summary criminal history information

dataset reason

dataset name

dataset charge 1

dataset charge 2

dataset charge 3

dataset charge 4

dataset dec para 6

POS Langauge

Execution

Doc Title

Formatted title

Address Line 2

Decl Para3

NDICA Clinic Intakes