Pico Rivera, CA · Los Angeles County
Financial Hardship Form
People named on a City of Pico Rivera administrative citation use this form to request a waiver of the administrative penalty based on financial hardship.
What this form is
This form lets a person named on a City of Pico Rivera administrative citation request a waiver of the administrative penalty based on financial hardship. It asks for citation and contact details, employment and household information, and each household member’s net monthly income. Applicants must attach supporting financial records, such as tax returns or bank records, and sign a declaration. Filing does not guarantee approval or extend the 10-calendar-day appeal period.
Who needs it
A person named on a City of Pico Rivera administrative citation who is requesting an administrative penalty payment waiver for financial hardship should complete this form.
How to submit it
Submit the form to the Community and Economic Development Department at 6615 Passons Blvd., Pico Rivera, CA 90660.
About notarization
This document is signed without a notary; the signer declares under penalty of perjury that the form and attached pages are true and correct.
How to submit this form
- 1
Download The Form
Download the Financial Hardship Form.
- 2
Complete The Form
Provide citation and contact details, employment information, household size, and each household member’s net monthly income.
- 3
Gather Supporting Records
Attach copies of supporting documents, such as tax returns, financial statements, bank account records, salary records, or public assistance verification.
- 4
Sign And Date
Sign and date the declaration confirming the form and attached pages are true and correct.
- 5
Submit To The Department
Submit the completed form to the Community and Economic Development Department at 6615 Passons Blvd., Pico Rivera, CA 90660.
Frequently asked questions
- What does the Financial Hardship Form request?
- It requests an administrative penalty payment waiver for financial hardship and asks for citation, contact, employment, household, and income details, with supporting records.
- Do I need a notary for the Financial Hardship Form?
- No. The signer signs and dates the form and declares under penalty of perjury that the information and attached pages are true and correct.
- How do I submit the Financial Hardship Form?
- Submit it to the Community and Economic Development Department at 6615 Passons Blvd., Pico Rivera, CA 90660.
- Does filing the form extend the appeal period?
- No. The form states that filing does not extend the 10-calendar-day appeal period, and filing does not mean the request will qualify.
Need something notarized?
This Financial Hardship Form doesn’t need a notary — but if you have another Pico Rivera form that does, a commissioned online notary can help.