ORANGE COUNTY PUBLIC DEFENDER “NEW LEAF” APPLICATION
Personal Information |
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First Name |
Middle Name |
Last name |
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Other names used |
Date of Birth |
Place of birth |
Social Security # |
CDL# |
Today’s Date |
Contact Information |
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Street Address |
Apt. # |
City |
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Zip Code |
May we leave a message for you at these contact numbers if you do not answer? |
No |
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Case Information |
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O.C. Case # or date |
Additional case |
Additional case |
Did the Public Defender |
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represent you on this case? |
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No |
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Yes |
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Have you had any other |
arrests or convictions from |
other counties? If yes, please complete below: |
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Arrest or Conviction County |
Charges/conduct |
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Current Information |
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Are you currently on probation? |
No |
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Yes |
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Are you currently on parole? |
No |
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Yes |
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Are you currently serving a sentence? |
No |
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Yes |
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Are you currently charged with a crime? |
No |
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Yes |
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Which of the following types of relief are you interested in? |
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Seal and Destroy Arrest (I am factually innocent)
Early Termination of Probation (I am on probation and can provide good cause for early termination)
Reduce Felony to Misdemeanor (I am on probation, but when my conviction occurred, there was an agreement I could reduce my felony to a misdemeanor or (I am no longer on probation and would like my felony reduced)
Dismissal Pursuant to 1203.4 of the California Penal Code (formerly known as “expungement”)
Certificate of Rehab & Pardon (I was on probation and my conviction was expunged ) or
Certificate of Rehab & Pardon (I was not on probation, I served a State Prison Sentence)
WORKSHEET
This questionnaire will be used to assist us in preparing a statement to the judge. Please answer the questions on this form as completely as possible and return it to the New Leaf Program, Orange County Public Defender.
We will also need you to provide us with the following:
•3 to 5 character reference letters of addressed to The Honorable Judge of the Court from friends, family, employers, clergy, etc.
•Any school transcripts or diplomas (if you have attended school since your conviction)
•Any certificates of completion for rehabilitation or vocational programs (if you have attended any since your conviction)
•Community service documentation (if you were ever required to perform such service)
•Any other documentation you feel may help your case.
1.Why do you want Early Termination of Probation/Felony Reduction/Dismissal/ Certificate of Rehabilitation/Pardon?
2.How has your criminal record hurt your life?
3.How long has it been since your last conviction in any county? year(s)
4.How long has it been since your last arrest in any county? year(s)
5.Describe your past lifestyle and why you believe it caused your criminal offenses.
6.Describe your present lifestyle and explain why it has enabled you to be arrest/conviction free.
7.If you have had family support since your conviction or you provide support to your family, please describe how.
8.If you have been employed since your conviction, please describe the job and list the dates of employment.
9.If you have participated in any form of counseling since your conviction (court ordered or on your
own), please describe how it has benefited you and get copies of any certificates of completion or letter(s) from your counselor.
10.If you went to school or a job training program since your conviction, please describe them and get copies of diplomas, certificates of completion, proof of attendance and/or grades.
11.What kind of social organization do you belong to? (i.e., Church, Boys & Girls Club, etc)
12.Have you done any volunteer work for any organizations? If yes, please describe for whom and the dates of your activities. Please obtain a copy of any awards or certificates.
WORKSHEET
(CERTIFICATE OF REHABILITATION AND PARDON VERSION)
This questionnaire will be used to assist us in preparing a statement to the judge. Please answer the questions on this form as completely as possible and return it to the New Leaf Program, Orange County Public Defender.
(Complete the following only with respect to your most recent felony conviction)
On or about _____________, ________________, I was convicted of the felony of __________________
(month) (year)
________________________________, State of California. My sentence for this offense was
(State crime and code section)
(Check appropriate box):
□Commitment to state prison or other state institution at ________________________________.
□Probation with a suspended sentence to state prison or other state institution.
Thereafter, on or about ________________________, ________, I was (check appropriate box);
(month)(year)
□discharged from state prison or other state institution after completing my sentence;
□released on parole, from which I was finally discharged on ___________________, __________;
(month)(year)
□released from custody on probation or after serving a jail sentence as part of my probation, successfully
completed my probation on ________________, _______ and obtained relief under
(month) (year)
Penal Code Section 1203.4 on _________________, _____________.
(month)(year)
We will also need you to provide us with the following:
•3 to 5 character reference letters of addressed to The Honorable Judge of the Court from friends, family, employers, clergy, etc.
•Any school transcripts or diplomas (if you have attended school since your conviction)
•Any certificates of completion for rehabilitation or vocational programs (if you have attended any since your conviction)
•Community service documentation (if you were ever required to perform such service)
•Any other documentation you feel may help your case.