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––––– CR-
151
SUPERIOR COURT OF CALIFORNIA, COUNTY OF FOR COURT USE ONLY
STREET
ADDRESS
MAILING
ADDRESS
CITY AND ZIP
CODE
BRANCH
NAME
PEOPLE OF THE STATE OF CALIFORNIA
V
.
DEFENDANT
:
PETITION FOR CERTIFICATE OF IDENTITY THEFT
(PEN. CODE, § 530.6) CASE
NUMBER
1
. a. Your name ( person asking for the certificate ):
Your address ( if you want your address to be private, give a mailing address instead ):
Cit
y: Stat
e: Zip
Code:
Your telephone number (optional):
b. Your lawyer, if you have one ( specify name, address, telephone number, and State Bar number below ):
Nam
e:
Address
:
Telephone number:
State Bar
number:
2
. I have been the victim of the crime of identity theft. (If available, attach a copy of the report of the suspected crime of identity
theft, issued by the local law enforcement agency that has jurisdiction over your actual residence. Mark the report as
Attachment 2.)
3
. I need a Certificate of Identity Theft: Judicial Finding of Factual Innocence , because (check applicable boxes and fill in applicable
blanks
):
a
. An identity thief was cited in my name. (Attach a copy of the citation, if available. Mark it as Attachment 3a.)
(1) Date of citation: (3) Citation number:
(2) Violation of law stated in citation: (4) Agency that issued the citation:
This is not a Court
Order.
Page 1 of
3
Form Approved for Optional Use
Judicial Council of California
CR-151 [New January 1, 2005] PETITION FOR CERTIFICATE OF IDENTITY THEFT
(PEN. CODE, § 530.6) Penal Code, §
530.6elec troni c form ã
2005
WWW.LawCA.co
m
L a w
P u b l i s h e r s
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–––––PEOPLE OF THE STATE OF CALIFORNIA v.
DEFENDANT: CASE
NUMBER
b
. An identity thief was arrested in my name. (Attach a copy of the warrant, if available. Mark it as Attachment 3b.)
(1) Date of arrest:
(2) Arrest warrant number: (3) Arresting agency:
(4) Agency that issued the warrant:
c
. An identity thief was convicted of a crime in my name. (Attach a copy of the judgment of conviction, if available. Mark it
as Attachment 3c.)
(1) Date of conviction: (3) Name of court:
(2)
Crime: (4) Case
number:
d
. A criminal complaint has been filed against an identity thief in my name. (Attach a copy of the criminal complaint, if
available. Mark it as Attachment 3d.)
(1) Name of court:
(2) Case number:
e
. My identity has been mistakenly associated with a record of criminal conviction.
(1) Date of conviction:
(2) Case involved (describe subject matter of case):
f
. I was arrested for a crime committed by an identity thief using my name. (Attach a copy of the arrest warrant, if
available. Mark it as Attachment 3f)
(1) Date of arrest:
(2) Arrest warrant number:
(3) Agency that issued the warrant:
(4) Arresting agency:
(5) Date I submitted my petition to the arresting agency under Penal Code section 851.8:
(6) Date the arresting agency denied that petition:
(Attach copy of the petition, if available. Mark it as Attachment 3f.)
4
. There is no reasonable cause to believe that I committed the offense for which the identity thief was arrested, cited,
convicted, or was the actual subject of a criminal complaint in my name; or there is reasonable cause to believe
that my identity has been mistakenly associated with a record of criminal conviction.
This is not a Court
Order.
CR-151 [New January 1,
2005] PETITION FOR CERTIFICATE OF IDENTITY THEFT
(PEN. CODE, § 530.6) Page 2 of
3elec troni c form ã
2005
WWW.LawCA.co
m
L a w
P u b l i s h e r s
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––––– –––––
–––––
––
Number of pages attached: –––––
–––––
–––––PEOPLE OF THE STATE OF CALIFORNIA v.
DEFENDANT: CASE
NUMBER
5
. I will provide to the judge my basic personal identification information, such as my full name, date of birth, gender,
weight, height, natural hair color, natural eye color, race, age, driver's license or identification number, and fingerprints (if
required by the court); however, such information is not included in this petition in order to avoid further publishing the
information.
6
. The following additional facts and/or designated exhibits support this petition:
Continued on Attachment 6.
7
. I understand that the court may vacate the certificate of identity theft at any time if this petition, or any part of the
information submitted in support of this petition, is found to contain any material misrepresentations or fraud.
8
.
I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct.
Dat
e:
Sign your
name
Print your
name
This is not a Court
Order.
CR-151 [New January 1,
2005]
PETITION FOR CERTIFICATE OF IDENTITY THEFT
(PEN. CODE, § 530.6) Page 3 of
3elec troni c form ã
2005
WWW.LawCA.co
m
L a w
P u b l i s h e r s
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