Case Number  

APPLICATION FOR REDUCTION  
OF PENALTY ASSESSED UNDER  
THE DEMAND REDUCTION ASSESSMENT ACT  

Form C-76        Rev. 12/90 

tate of Alabama  

Unified Judicial System  

  S

N THE_______________________________________ COURT OF__________________________________, ALABAMA  
 
 

      (Circuit, District or Municipal)  

(County or Municipality)  

 

 

 

 STATE OF ALABAMA       v. _____________________________________________________________, Defendant  

      I, the Defendant, hereby certify under penalty of perjury that I have successfully completed a drug rehabilitation program 

approved by the court and herewith submit a summary of my expenses associated with the program. I further certify that the 

amounts  listed  accurately  represent  expenses  actually  paid  by  me  and  request  that  the  court  reduce  the  penalty  imposed 

under Section 13A-12-284, Ala. Code 1975, Demand Reduction Assessment Act, by the amount of $ _________________, 

as provided by the Act. Itemized costs: (attach original receipts/other documentation form)  

__________________________$_______________ 

        _______________________________$_____________ 

___________________________$_______________ 

        _______________________________$_____________ 

___________________________$_______________ 

        _______________________________$_____________ 

___________________________$_______________ 

        _______________________________$_____________ 

 

 

 

 

 

 

        TOTAL EXPENSES $___________________________ 

______________________,20_______.  
 

 

 

 

 

        ___________________________________      _____________________ 
        Defendant  

            Date 

 

 

 

worn to and subscribed before me this  

___________________________________ 
Signature of Court Official  

CERTIFICATION OF CRO OR PROGRAM DIRECTOR  

        I, certify that the above named defendant   (cid:133) did   (cid:133) did not   successfully complete the assigned drug rehabilitation 
program approved by the court.  

_____________________________________         ________________________________       ____________________ 

Name (Please Print) 

 

 

 

 Signature  

 

 

 

Title  

_________________________________________________________________________________________________ 

Agency  

COURT ORDER TO REDUCE DEMAND REDUCTION ASSESSMENT PENALTY  

       Having determined that the defendant in this case successfully completed an approved drug rehabilitation program and 
having  reviewed  the  defendant’s  application  for  reduction  of  the  penalty  imposed  pursuant  to  the  Demand  Reduction 
Assessment  Act,  including  defendant’s  statement  of  expenses  associated  with  such  rehabilitation  program,  it  is  hereby 
ORDERED  that  the  defendant’s  penalty  imposed  pursuant  to  the  Demand  Reduction  Assessment  Act  be  reduced  by  the 
amount of $__________________________. 

_______________________________________________________   
 

Judge    

 

 

 

 

 

 

 
 

  ___________________________ 
  Date 

   

  I

       

  (cid:133)

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  S

 

   

   

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riginal: Court  
 

          Copy 1: Department of Corrections   Copy 2: Defendant