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Defendants Request And Declaration To Vacate Civil Assessment TR-121 - California
| Defendants Request And Declaration To Vacate Civil Assessment Form. This is a California form and can be used in Traffic Contra Costa Local County . |
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Superior Court of California, County of Contra Costa P.O. Box 5128 Walnut Creek, CA 94596-5128 CIVIL ASSESSMENT PETITION AND ORDER DEFENDANT'S REQUEST AND DECLARATION TO VACATE CIVIL ASSESSMENT Defendant's Name __________________________________________ Requesting to Vacate (mark one): FAILURE TO APPEAR Case Number ____________________ FAILURE TO PAY MUST SUBMIT SEPARATE FROM FOR EACH TYPE OF REQUEST IMPORTANT: Written proof of any of the following that shows you were unable to appear or contact the court must be attached or petition will be returned. HOSPITALIZED INCARCERATED MILITARY DUTY The following is an explanation of my failure(s) to appear and/or pay: (Please print and include attachments) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge and that written proof is attached to this form. Executed at ________________________________________ on _____________________ City and State Date RESIDENTIAL TREATMENT DEATH CERTIFICATE NOT PERSON CITED CLERICAL ERROR Address __________________________________________________ ________________________________________________ Telephone # ______________________ Signature ____________________________________ ORDER re. CIVIL ASSESSMENT (COURT USE ONLY) The Court having read and considered the Petition regarding vacating the Civil Assessment pursuant to PC 1214.1(B), hereby makes the following order: Defendant's Petition to Vacate is: FTA GRANTED FTP GRANTED Signature ____________________________________ Commissioner FTA DENIED FTP DENIED Date _________________ For questions on your fine amount, please call or contact the appropriate court location below. Walnut Creek Court 640 Ygnacio Valley Rd Walnut Creek, CA 94596 Pittsburg Court 1000 Center Drive Pittsburg, CA 94565 Richmond Court 100 37th Street Richmond, CA 94805 (925) 646-4099 Local Court Form Mandatory TR-121 Rev 2/21/13 American LegalNet, Inc. www.FormsWorkFlow.com
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