Mesa

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Second Chance Application

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Name *

Address (if not protected)

City *

State *

Zip Code *

Phone *

Email *

STATE OF ARIZONA - Plaintiff

Defendant *

APPLICATION FOR CERTIFICATE OF SECOND CHANCE A.R.S. § 13-905(L)

Case Number *

The Defendant in the case identified above hereby requests a Certificate of Second Chance pursuant to A.R.S. § 13-905(L). Defendant is eligible for a Certificate of Second Chance because Defendant previously received a set aside order on

in this case that did not include a Certificate of Second Chance.

Please note: To qualify for a Certificate of Second Chance, those applicants who were convicted of a class 4, 5, or 6 felony must wait to submit an application until two years after fulfilling the conditions of probation or sentence. Those applicants who were convicted of a class 2 or 3 felony must wait five years after fulfilling the conditions of probation or sentence. Applicants convicted of a misdemeanor may immediately apply.

Conviction Reason *

A Judgment of Guilt was entered in this Court against the defendant on the day of

, on the conviction of:

Count I *

Count II *

Count III *

Count IV *

Case Number *

I understand that this application may be denied if information in this application is found to be inaccurate. I declare under penalty of perjury that, to the best of my knowledge, the information provided in this application and any attachments is true and correct.

Print Defendant’s Name *

Address

OR AUTHORIZATION TO PROCEED ON BEHALF OF DEFENDANT

I authorize my Attorney

Name

to file this application for a Certificate of Second Chance with the Court.

To the best of my knowledge, the information provided in this application is true and correct.

Print Attorney Name

Attorney Address

Created by AIPSS

Mesa

Second Chance Application

Person Filing Details

Case Details

Conviction Details