Fill and Sign the 18 13 122 Form

County Court _________________________ County, Colorado Court Address: State of Colorado v. Defendant: _______________________________________ COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION TO SEAL RECORDS RELATED TO ILLEGAL POSSESSION OR CONSUMPTION OF ETHYL ALCOHOL BY AN UNDERAGE PERSON (MIP) PURSUANT TO §18-13-122(10), C.R.S. (AS IT EXISTED PRIOR TO JULY 1, 2014) I, ________________________________________________, (Name of Defendant), petition this Court to seal records related to the above-captioned case involving illegal possession or consumption of ethyl alcohol by an underage person. 1. Information about the Defendant: Date of Birth: _______________________________ Current Mailing Address: ___________________________________________________________________ City, State and Zip Code: __________________________________________________________________ Home Phone #: _________________ Work Phone #: __________________ Cell #: ____________________ 2. I request that the following information be sealed: Date of Offense Name of Law Enforcement Agency Arrest/Summons Number 3. One year has passed since:  the date of my conviction,  the date my case was dismissed,  the date I completed my deferred judgment, or  the date my deferred prosecution concluded, for a violation of §18-13- 122(2), C.R.S. (as it existed prior to July 1, 2014); whichever is later. 4. I have not been arrested for, charged with, or convicted of any felony, misdemeanor, or petty offense during the one year period following the date of my conviction for a violation of §18-13-122(2), C.R.S. (as it existed prior to July 1, 2014).  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE __ ______________________________________ ____________________________________________ (Printed name of Petitioner/Defendant) Signature of Petitioner/Defendant Date ________________________________________ Signature of Attorney Date JDF 313(a) R3-18 PETITION TO SEAL PURSUANT TO § 18-13-122(10), C.R.S. (AS IT EXISTED PRIOR TO JULY 1, 2014) Page 1 of 1