Getting Started Request to Expunge & Impound and/or Seal ... · Getting Started Request to Expunge & Impound and/or Seal ... Arrests nr Cases for Expungement form a~~d check the

Find Illinois Supreme Court approved forms at: http://www.illinoiscourts.gov/Forms/approved/. EX-G 2901.1 Page 1 of 1 (09/17)

Getting Started Request to Expunge & Impound and/or Seal Criminal Records IMPORTANT: This getting started guide and the instructions are not legal advice. They are only meant to help you learn how to expunge and/or seal your criminal record. Your use of the forms does not guarantee you will be successful in court.

To learn how to fill out the forms and file them with the court, read the How to Expunge and/or Seal a Criminal Record instruction booklet and the instructions on the forms.

Names of forms: • Request to Expunge & Impound and/or Seal Criminal Records• Notice of Filing for Expungement and/or Sealing• Order to Expunge & Impound and/or Seal Criminal Records• Order Denying Request to Expunge & Impound and/or Seal Criminal

Records• Additional Arrests or Cases for Expungement (if needed)• Additional Arrests or Cases for Sealing (if needed)• Additional Notice of Filing for Expungement or Sealing (if needed)

Purpose of the forms: To erase arrests, court supervisions, and some types of probation from your criminal record so it is like they never happened. To hide certain criminal convictions from public view.

Types of cases the forms CAN be used for:

When you have been arrested or charged with criminal offenses or convicted of an eligible criminal offense. See How to Expunge and/or Seal a Criminal Record for a complete list of eligible offenses.

Types of cases the forms CANNOT be used for:

• Minor traffic cases (where you were charged in court). Although minortraffic offenses cannot be expunged, you can still expunge othereligible criminal records when your record includes both.

• Eviction cases (use eviction forms (when approved) or motion formsfound at: http://www.illinoiscourts.gov/Forms/approved/)

• Other felonies—see How to Expunge and/or Seal a Criminal Recordfor a complete list of ineligible offenses.

Cost to file the forms: Yes, there are costs to file the forms. If you cannot afford to pay the filing fee, you can ask the court to file for free by filing the Application for Waiver of Court Fees found at: http://www.illinoiscourts.gov/Forms/approved/

Special information or papers needed to complete the forms:

• Details about the arrests and charges in your criminal record;• Addresses of police departments that arrested you;• Addresses of the State’s Attorney’s offices that filed charges against

you; AND• Addresses of chief legal officers where you were arrested.

Statutes covering the forms: 20 ILCS 2630/5.2 Where to find the forms and

instruction sheet: www.illinoiscourts.gov/Forms/approved/

For more information: Read the How to Expunge and/or Seal a Criminal Record instruction booklet that comes with these forms. You may also find more information, resources, and the location of your local county self help center at: www.illinoislegalaid.org/Sealing or www.illinois.gov/osad/Expungement.

This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.

STATE OF ILLINOIS,

CIRCUIT COURT REQUEST TO EXPUNGE &IMPOUND AND/OR SEAL

COUNTY CRIMINAL. RECORDS

Instructions ~

Enter above the RGqueSt of:

county name whereyou will file this case.

Enter your name, binh Your name (First, middle, last name)

date, race, aid gender.List anv other namesyou used when Other names used in these casesarrested on the caseslisted on this form.

If the C(erk gave you ane~v case number,enter it tc~ the right.

Enter the number forall eligible arrests andcharges on yourcriminal record iii thisec~unty. If an arrest didnot result in formalcharges, enter thearrest number.

Date of birth Race Gender Case Number (if the Clerkassigns a new number)

Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County:

IF YOU ARE ONLYREQUESTIN(> TOSEAL CASES, DONOT FILL OUTSECTIONS 2 - 11.GO TO SECTION 12.

Sep How to Fxp~~ngeancUor Seat a CriminalRecord to make sure allof your cases can beerased by expungingyour record. For helpfilling out this table, seepages 12 — 15. Do notlist any convictions inthis section.

In 2, enter all eligiblearrests or charges onyour record. Enter allcharges for eael~ casenumber.

For Outcome, enter anoutcome that matchesthe otiitcon~e of yourcase. Use theshortened version ofthe outcome from theOutcomeAbbreviations box.

If you need more room,use the Additio~ralArrests nr Cases forExpungement form a~~dcheck the box.

1. I am requesting to expunge and impound records.

Yes ❑ No (lf no, go to Section 13)

2. I ask the Court to EXPUNGE AND IMPOUND the following arrests or charges from the

records of the Arresting Agency, the Circuit Clerk, and the Illinois State Police. I was arrested,

or charged without being arrested, and not convicted on the dates and for the offenses listed below:

Arrest orCase Number

ArrestingA envy

Charge(list all charges for each case number)

Date ofArrest

Outcome(for

exam le,pRV, S orP)

Outcome Abbreviations

RV Conviction Reversed or Vacated P Pardon from the Governor

CE Certificate of Eligibility for Expungement from PRB F) Found Factual) Innocent

RWG Released Without Ghar e DA Dismissal or Ac uittal

S Supervision Successfully Completed QP Qualified Probation Successful) Com leted

U I have listed additional arrests or cases on the attached Additional Arrests or Cases for

Expungement form.

EX-R 2903.2 Page 1 of 4 (09/17)

In 3-11, check ALLboxes that apply.

In 3, you cannotexpunge a criminalconviction unless oneof the special situationslisted under eheekboxesa, b, c, or d describes

In 7, your record mustspecifically state thatyou had QualifiedProbation. It might alsobe called SecondChance, 410, 710,1410, or TASC

In 8, if you gotsupervision for any case,5 years must havepassed since the end ofthe sentence for:• Domestic Battery;• Criminal SexualAbuse;• Driving without iInsurance; ~• Driving withregistration suspended ',for Non-Insurance;• Display of False iInsurance Card; ',• Scrap Processors toKeep Records; lJR '~• 2 years must passsince the end of thesentence for all othersupervisions (exceptthose listed in 9, whichcan never beexpunged).

tF YOU ARE ONLYREQUESTING TOEXPUNGE CASES,DO NOT FILL OUTSECTIONS 13 - 22.

See How to Expungeand/or Seal a CriminalRecord to make sureyour cases can behidden by sealing yourrecord. For help fillingout this table see pages12 — I5.

Enter the Case Number given by the Circuit Clerk:

3. (was not convicted of any offenses (want to expunge, unless (Check the box thaf applies):

a. ❑ I was convicted, but the conviction was reversed or vacated; OR

b, ❑ I received a pardon from the Governor of the State of Illinois allowing

expungemertt. (Attach a copy of the pardon.); OR

c. ❑ I received a Certificate of Eligibility for Expungement by the Prisoner Review

Board. (Attach a copy of the Certificate.); OR

d. ❑ I was found factually innocent in the case I am asking to expunge.

4. ❑ For at least one case, I was arrested and released, and no charges were filed against me.

5. ❑ For at least one case, I was arrested for a minor traffic offense and released from

custody without being charged.

6. ❑ For at least one case, I was charged, but was later acquitted, or released without

being convicted.

7. ❑ For at least one case, I received a sentence of Qualified Probation; AN'D

a. At least 5 years have passed since my Qualified Probation ended successfully;

AND

8. aa.

b.

9. ❑

a.

b.

c.

10. ❑

a.

b.

C.

41. ❑

i have attached the results of a drug test that I passed within the last 30 days.

For at least one case, I received a sentence of supervision; AND

❑ For certain offenses listed in the law, at least 5 years have passed since

completed my supervision successfully; OR

❑ At least 2 years have passed since I completed my supervision successfully.

i am NOT seeking to expunge any arrests or charges that resulted in supervision for:

Driving Under the Influence; OR

Any sexual offense against a person under the age of 18; OR

Reckless Driving when I was 25 years of age or older.

For at least one case, I received a sentence of supervision for Reckless Driving; AND

was under the age of 25 when the offense was committed; AND

have no other convictions far DUI or Reckless Driving; AND

have reached the age of 25.

qualify to have my filing fees and State Police fees waived under the Cook County

Fee Waiver Pilot Program:

am filing this Request in Cook County prior to January 1, 2018; AND

am only seeking to expunge or seal arrests that resulted in my release without being

cases that resulted in my acquittal, dismissal of the case, or a reversed or vacated

conviction.

12. I am requesting to seal records.

❑ Yes ❑ No (if no, skip Sections 73- 22)

EX-R 2903.2 Page 2 of 4 (09/17)


In 13, enter all eligiblearrests, charges, andconvictions you wantsealed. Enter alicharges for each casenumber. For Outcome,enter an outcome thatreflects the outcome o€your case. Use theshortened version ofthe outcome from theOutcomeAbbreviations box.

If you need more roomto list additionaleligible arrests orcharges use theAdditior2al Arrests or

Cases for Sealnig formand check the box.

14-16 must be true foryou to use this fom~.

For 14, traffic offensescannot be sealed unlessthey were an eligibleClass A or Bmisdemeanor.

In 17 - 21, check ALLboxes that apply.

In 17 and 18a —e, somemisdemeanorsupervisions andconvictions cannot besealed, like DUI, someReckless DrivingOffenses, DomesticBattery, some SexualOffenses, and DogFighting.In I8b, some Class 3

and Class 4 felonyoffenses can tae sealed,like ThefC, Possession

of Cannabis,Possession of aControlled Substance,and a few others.

For a complete list ofcrimes that can andcannot be sealed, seethe How to Expacngeandlor Sea/ a CriminalRecord.

In 21, check the box ifyou have completed oneof'the listed educationalgoals during your lastsentence. If 21 applies toyou, all eligible casescan be sealedimmediaCely after thecainpletion of your lastsentence.

13. I ask the Court to SEAL the following arrests, charges, or convictions from the records of theArroe4inn ~nanry tha rircnit C'.lark anri tha Illinois .~',tata Pnlira•

Arrest or CaseNumber Arresting

A enc

Charge

(listalichargesforeachcasenumber

Date ofArrest

Outcome (forexample, MC,FC, or CE


MC Misdemeanor Conviction FC Felon Conviction

CE Certificate of Eli ibilit for Sealin from PRB QP Qualified Probation Successful) Cam leted

❑ i have listed additional arrests or cases on the attached Additional Arrests or Cases for

Sealing form.

14. i am not asking to seal arrests or charges for minor traffic offenses, unless I was released

without being charged.

15. I am not asking to seal arrests or charges for felony offenses, unless the felony was reduced

to an eligible misdemeanor, or is otherwise eligible to be sealed.

16. I am not asking to seal a felony conviction that happened after the sealing of a prior felony

conviction.

17. ❑ At least 2 years have passed since I successfully completed my supervision, for eligible

offenses.

18. At least 3 years have passed since the end of my last sentence (Unless #20 applies); AND

(Check all that apply):

a. ❑ I received a misdemeanor conviction for an offense subject to sealing;

b. ❑ I received a felony conviction for an offense subject to sealing. If it was a drug case,

have attached the results of a drug test that I passed within the last 30 days.

c. ❑ I successfully completed a sentence under Section 10 of the Cannabis Control Act,

Section 410 of the Illinois Controlled Substances Act, Section 70 of the

Methamphetamine Control and Community Protection Act, or Section 5-6-3.3

(Second Chance Probation) of the Unified Code of Corrections; AND i have

attached the results of a drug test that I passed within the last 30 days.

19. ❑ I am not asking to seal a felony conviction for which i currently have to register on a

public registry, including the Arsonist Registration Act, the Sex Offender Registration Act,

or the Murder and Violent Offender Against Youth Registration Act.

20. ❑ For at least one case, I received a Certificate of Eligibility for Sealing by the Prisoner

Review Board. (Attach a copy of the Certificate.)

21. ❑ I am eligible to seal all eligible cases upon completion of my LAST sentence because

i received a high school diploma, associate's degree, career certificate, vocational or

technical certification, or bachelor's degree, or passed the high school GED Test; AND

a. I did so during the period of my LAST sentence, aftercare release, or mandatory

EX-R 2903.2 Page 3 of 4 (09/17}

Enter the Case Number given by the Circuit Glerk;

Under the Code ofCivil Procedure, 735ILCS 5/1-109, makinga statement on thisform that you know tobe false is perjury, aClass 3 Felony.

Enter your name,address, and phone, or

that of your attorney, if

you have one.

DO NOT fill in thebox to the right.

supervised release; AND

b. I did not complete the same educational goal before.

c. I have attached to this Request proof of the program I completed.

22. ❑ For at least one case, I received a conviction for Reckless Driving; AND

a. I was under the age of 25 when the offense was committed; AND

b. i have no other convictions for DUI or reckless driving; AND

c. I have reached the age of 25.

certify #hat everything in the Request To Expunge 8 Impound andlor Seal Criminal

Records is true and correct. 1 understand making a false statement on this form is perjury

and has penalties provided by law under 735 ILCS 5/1-109.

Your Signature

Prepared by:

Street Address:

City, State, ZIP:

Phone Number:

Date

For official use only

State's Attorney/ProsecutorllSP/Arresting

Agency/Chief focal Legal Officer:

Received on:

EX-R 2903.2 Page 4 of 4 (09117)


FATE OF ILLINOIS,CIRCUIT COURT

Instructions ~

inter above the countyname where you willfile this case.

Enter your name, birthdate, race, and gender.List any other namesyou used whenarrested on the caseslisted on this form.If the Clerk gave you anew case number,

Enter the number forall eligible arrests andcharges on yourcriminal record in thiscounty. I~f an arrest didnot result in formalcharges, enter thearrest number.

COUNTY

Request of:

1. To: County State's AttorneyCounty Name

Your name (First, middle, last name)

Other names used in these cases

For Court

Date of birth Race Gender Case Number (if the Clerk

assigns a new number)

Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County:

In 1, enter the State'sAttorney office thatprosecuted your cases.

In 2, enCer the localpolice agencies thatarrested yoii.

If yotii run out of space,use the AdditionalNotice of Fili~ag forExpungemerzt and/orSealing form andcheck the box.

In 3, enter the namesand addresses of theChief Legal Officer ofthe Unit of LocalGovernment thatarrested you.

The Chief Legal Officeris usually the lawyer for',the city or town inwhich you werearrested or, in somecases, if you werearrested by the sheriff,it is the State's Attorneyfor that county.

If you run out of space,use Che AdditionalNotice of Filing forExpungement and/orSealing form and checkthe box.

EX-N 2904.1

NOTICE OF FILING F412EXPUNGEMENT AND/OR

SEALING

Address City State Z/P

2. To: Arresting Agencies that arrested. you:

Name Name

Street Address Street Address

City State Z!P City State ZIP

❑ I have listed additional Arresting Agencies on the attached Additional Notice of

Filing for Expungement and/or Sealing form.

3. To: Chief Legal Officers of the Units of focal Government that arrested you:

Name Name

Street Address Sfreet Address

City State ZlP City State ZlP

❑ I have listed additional Ghief Legal Officers on the attached Additional Notice of

Filing for Expungement and/or Sealing form.

4. To: Illinois State Police

260 North Chicago Street

Joliet, Illinois 60432

Page 1 of 2 (09117)


1n 5, enter the name of 5. I have filed a Request to Expunge &Impound and/or Seal Criminal Recordsthe county where you with the Clerk of the Circuit Court of County, Illinois.are filing your Request. County Name

In 6, check the box if 6. ❑ I am seeking a fee waiver under Supreme Court Rule 298, or have attached an Orderyou have or are getting waiving my filing and State Police fees.a fee waiver.

7. The Circuit Court Clerk will mail a copy of this Notice and the Request to all of the agencies

listed above in sections 1 - 4.

After you finish thisform, sign it, and enterthe date.

Enter your name,address, and phonenumber.

DO NOT fill out thissection. Tl~e CircuitClerk will sign andmail it.

Your Signature

Prepared by: _

Street Address:

City, State, ZIP: _

Phone Number:

CERTIFICATE OF MAILING

Date

The undersigned certifies that the above Notice and attached documents were placed in the U.S.

Mail with first class postage prepaid to all parties listed above.

Signature of Circuit Clerk of Deputy Clerk

EX-N 2904.1 Page 2 of 2 (09/17}

This form is approved by the Illinois Supreme Court and is required to be accepted in ali Illinois Circuit Courts.

STATE OF I~~INOIS,CIRCUIT COURT

Instructions ~

Enter above thecounty name whereyou will file this case.

Enter your name, birthdate, race, and gender.List any other namesyou used whenarrested on the cases

COUNTY

Request of:

ORDER TO EXPUNGE &IMPOUNDAND/OR SEAL CRIMINAL

RECORDS

Your name (Firsf, middle, last name)


If the Clerk gave yotii anew case number,enter it to the right.

In 1, enter the numberfor all cases listedunder Number 2 onthe Reguest farm forthe cases you want tohave expunged.If you completed an,4dditional Arrests o~-C'ases forExpungementform,fill out an additionalOrder and list thosecases.

In 2, enter the ntm~berfor all cases listedunder Number 14 onthe Request form forthe cases you want tohave sealed. If youcompleted anAdditional Arrests or

Cases for Sealingform, fill out anadditional Order andlist those cases.

for Court Use Only

Date of birth Race Gender Case Number (if the Clerkassigns a new number):

1. Arrest or Case Numbers of all Eligible Criminal Offenses for Expungement in this County:

❑ i have attached an additional Order form.

2. Arrest or Case Numbers of all Eligible Criminal Offenses for Sealing in this County:

❑ I have attached an additional Order form.

DO NOT check thisbox. The judge willcheck the correct boxes.

The judge will cross outthe case numbers thatare denied and includetheir on Che OrderDenying Reguest ToExpunge &Impound

and/or Seal CriminalRecords.

IT IS ORDERED:

~ Your Request for expungement is GRANTED for the above cases and within 60 days of

this Order.

• The Arresting Agencies must expunge these records as required by law.

• The Clerk of the Circuit Court must impound these records as required by law.

s The Illinois State Police must expunge or impound these records as required by law.

• The Illinois State Police and the Arresting Agencies must request the return of all arrest

or conviction records from any agencies that were previously notified of these records

as required by law.

• The Illinois State Police must expunge any pardoned conviction and other arrests by

sealing these records as required by law.

(Continued on next page)

EX-O 2905.1 Page 1 of 2 (09/17)


IT IS ORDERED:

DO NOT check this ~ Your Request for sealing is GRANTED for the above cases and within 60 days of receivingbox. The judge willcheck the correct box. this Ord@t"

The Illinois State Police, the Arresting Agencies, and the Clerk of the Circuit Court

must seal these records as required by law.

e The Illinois State Police and the Arresting Agencies must request the return of all

arrest or conviction records from any agencies that were previously notified of these

records as required by law.

DO NOT fill in these ENTERED:lines. The judge willsign and enter date here. Judge: Date:

EX-O 2905.1 Page 2 of 2 (09117}

This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Cireuit Courts.

STATE OF ILLINOIS, ~arC:r~urt Lice orty

CIRCUIT COURT ORDER DENYING REQUEST TOEXPUNGE &IMPOUND AND/OR

COUNTY SEAL CRIMINAL RECORDS

Instructions ~

Request of:Enter above thecounty name whereyou will file this case.

Enter your name, birth Your name (First, middle, last name)

date, race, and gender.List any other namesyou used whenarrested on the cases Other names used in these cases

listed on this form.

If the Clerk gave you

Case Number (if the Clerka new case number, Date of birth Race Genderenter it to the right. ass+gns a new number)

DO NOT fill in theselines. The judge will fillout and check thecorrect boxes.

DO NOT fill in theselines. The judge will tillout and check thecorrect boxes.

DO NOT fill in theselines. The judge willsign and enter date here.

IT IS ORDERED:

~ Your Request is DENIED for all cases sought to be expunged; OR

Your Request is DENIED for the following cases:

The reason your Request is denied for these cases: (check all that apply)

Your records are not legally eligible to be expunged.

You failed to attach the required drug test.

The court finds that the public's interest in retaining your criminal records is greater

than your interest in expunging your records.

Other:

IT IS ORDERED:

Your Request is DENIED for all cases sought to be sealed; OR

Your Request is DENIED for the following cases:

The reason your Request is denied for these cases: (check ail that apply)

❑ Your records are not legally eligible to be sealed.

❑ You failed to attach the required drug test.

❑ The court finds that the public's interest in retaining your criminal records is greater

than your interest in sealing your records.

❑ Other:

..- Date:

EX-DO 2906.1 Page 1 of 1 (09/17}


STATE OF ILLINOIS,CIRCUIT COURT

Instructions ~

Enter above the countyname where you willfile this case.

Enter your name, birthdate, race, and gender.List any other namesyou used whenarrested on the caseslisted on this form.If the Clerk gave you anew case number,

Enter the number forall eligible arrests andcharges on yourcriminal record in thiscounty. If an arrest didnot result in forinaicharges, enter thearrest number.

COUNTY

Request of:

ADDITIONAL NOTICE OF FILINGFOR EXPUNGEMENT ANDIOR

SEALING

Your name (First, middle, last name)


Date of birth Race Gender Case Number (if the Clerk

assigns a new number)

Arrestor Case Numbers of all Eligible Criminal Offenses on your Record in this County:

In 1, enter theadditional local policeagencies that arrestedyou.

In 2, enter the namesand addresses of theadditional Chief LegalQfficers of the Units '~of Local Government ',that arrested you.

The Chief LegalOfficer is usually thelawyer for the city or

town in which youwere arrested.

City State ZIP City State ZIP

After you finish thisform, sign it and enterthe date and attach itto the Notice of Filingfor Expungementand/or Sealing.

Your Signature

Enter your name, Prepared by:address, and phone, orthat of your attorney, StfOet Addi'eSS:if you have one.

City, State, ZIP:

Phone Number:

Date

EX-AN 2910.1

1. To: Additional Arresting Agencies that arrested you:

Name Name


City Stafe Z!P City State ZIP

2. To: Additional Chief Legal Officers of the Units of Local Government that arrested you:

Name Name


Page 1 of 1 (09117)


STATE OF ILLINOIS, far court Use Uniy

CIRCUIT COURT ADDITIONAL ARRESTS OR

COUNTY C/~SES FOR EXPUNGEMENT

Instructions ~

Request Of:inter above thecounty name whereyou will file this case.

Enter your name, birth Your name (First, middle, last)date, race, and gender.List any other namesyou used when

Other names used in these cases Case Number (if the Cierk assigns aarrested on the caseslisted on this form. new number)If the Clerk gave you anew case number, Date of birth Race Genderenter it to the right.

Enter the number for Arrest or Case Numbers of Additional Criminal Offenses in your Record in this County:each additional arrest,charge, and convictionyou want expunged. Ifan arrest did not resultin formal charges,enter arrest number.

See How to Expungeand✓or Seal a CriminalRecord to make sure allof your cases can beerased by expungingyour record. For helpfilling out this table,see pages 12 — 15.

Enter the additionaleligible arrests orcharges on your recordthat you wantexpunged, but couldnot fit on the Request.Enter ail charges foreach case number.

For Outcome, enter anoutcome that reflectsthe outcome of yourcase. Use theshortened version ofthe outcome from theOutcomeAbbreviations box.

After you finish thisform, sign it and enterthe date and attach it tothe Request.

Enter your name,address, and phone, orthat of your attorney,if you have ane.

Arrest orGase Number

ArrestingA enc

Chargelist all cha es for each case number

Date ofArrest

Outcome(for

example,RV, S orP)


RV Conviction Reversed or Vacated P Pardon from the Governor

CE Certificate of Eli ibilit for Ex un ement from PRB FI Found Factual) innocent

RWC Released Without Char e DA Dismissal or Ac uittal

S Supervision Successfully Completed QP Qualified Probation Successful) Com leted

Your Signature

Prepared by:

Street Address:

City, State, ZIP:

Phone Number:

Date

EX-AA 2907.1 Page 1 of 1 (09/17)


STATE OF ILLINOIS, for Court flee C3nJyCIRCUIT COURT ADDITIONAL ARRESTS OR

COUPITY CASES FOR SEALING

Instructions ~

Request of:Enter above thecounty name whereyou will file this case.

Enter your name, birth Your name (First, middle, last)date, race, and gender.List any other namesyou used whenarrested on the cases Other names used in these cases

listed on this form. Case Number (if the Clerk assigns anew number)If the Cierk gave you a

new case number, Date of birth Race Genderenter it to the right.

Enter the number for Arrest or Case Numbers of Additional Criminal Offenses in your Record in this County:each additional arrest,charge, and convictionyou want sealed. If auarrest did not result informal charges, enterarrest number.

See How to Expungeandlor Seal a Crir~r~inalRecord to make sure allof your cases can behidden by sealing yourrecord. For help fillingout this table, see pages12— 15.

Enter all additionaleligible arrests,charges, andconvictions you wantsealed, but could not fiton the Request. Enterall charges for eachcase number.

For Outcome, enter anoutcome that reflectsthe outcome of yourcase. Use theshortened version ofthe outcome from theOutcomeAbbreviations box.

After you finish thisform, sign it and enterthe date and attach it tothe Request.

Enter your name,address, and phone, orthat of your attorney,if you have one.

Arrest orCase Number

ArrestingA enc

Chargelist all cha es for each case number

Date ofArrest

Outcome (forexample, MC,FG, or CE)


MC Misdemeanor Conviction FC Felon Conviction

CE Certificate of Eligibility for Sealing from PRB QP Qualified Probation Successful) Com leted

Your Signature

Prepared by:

Street

City, State,

Phone

Date

SE-AA 2908.1 Page 1 of 1 (09/17}

Documents

Getting Started Request to Expunge & Impound and/or Seal ... · Getting Started Request to Expunge & Impound and/or Seal ... Arrests nr Cases for Expungement form a~~d check the