Fill and Sign the Application for Reduction of Penalty Assessed under Forms

State of Alabam a Unified Judicial System Form C-76 Rev. 12/90 APPLICATION FOR REDUCTION OF PENALTY ASSESSED UNDER THE DEMAND REDUCTION ASSESSMENT ACT Case Number IN T HE_______________________________________ COURT OF __________________________________, A LABAMA (Circuit, District or Municipal) (County or Municipality) … STAT E OF AL AB AM A v. _____________________________________________________________, Defendant I, the Defendant, hereby certify under penalty of perju ry that I have successfully co mpleted a drug rehabilitation progr am approved by the court and herew ith submit a summary of my expenses associated w ith the program. I furt her certify that the amounts listed accurately repr esent expenses actually paid by me and request that the c ourt reduce the penalty imposed under Section 13A-12-284, Ala. Code 1975 , Demand Reduction Assessment Ac t, by the amount of $ _________________, as provided by the Act. Itemized costs: (attach original receipts/other documentation form) ___________________________$_______________ _______________________________$_____________ ___________________________$_______________ _______________________________$_____________ ___________________________$_______________ _______________________________$_____________ ___________________________$_______________ _______________________________$_____________ T OTAL EX PENSES $___________________________ Sw orn to and subscribed before me this ______________________,20_______. ___________________________________ _____________________ Defendant Date ___________________________________ Signature of Court Official CERTIFICATION OF CRO OR PROGRAM DIRECTOR I, certify that the above named defendant … did … did not successfully comple te the assigned drug rehabilitation program approved by the court. ______________________________________ ________________________________ ____________________ Name (Please Print) Signature T itle ________________________________________________________________________\ __________________________ Agency COURT ORDER TO REDUCE DEMAND REDUCTION ASSESSMENT PENALTY Having determined that the defendant in this case successfully completed an approv ed drug rehabilitation program and having review ed the defendant’s application for reduction of the penalty imposed pursuant to the Demand Reduction Assessment Act, including defendant’s statement of expenses asso ciated w ith such rehabilitat ion program, it is hereby ORDERED that the def endant’s penalty imposed pursuant to the Demand Reduction Asse ssment Act be reduced by the amount of $__________________________. ________________________________________________________ ___________________________ Judge Date Orig inal: Court C opy 1: Depar tment of Cor recti ons Copy 2: Defendant