Fill and Sign the Arrest Form

District Court _________________________ County, Colorado Court Address: Petition of: Person in Interest (Primary subject of the criminal justice record) 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 ARREST AND CRIMINAL RECORDS OTHER THAN CONVICTIONS PURSUANT TO §24-72-702, C.R.S. 1. The Petitioner is: (check one only)  the Person in Interest that is the primary subject of the criminal justice record.  the designated representative of the Person in Interest, by power of attorney or notarized authorization.  the parent of the Person in Interest, if the Person in Interest is under legal disability.  the appointed legal representative of the Person in Interest, if Person in Interest is under legal disability. 2. Information about the Person in Interest: Date of Birth: Current Mailing Address: City: State: Zip Code: Home Phone #: Work Phone #: Cell #: 3. The Petitioner asks this Court for an Order to Seal Arrest and Criminal Records information in the custody of the following agencies:  District and County Courts  Sheriff’s Department  District Attorney  Law Enforcement Agency (name of agency)  Municipal Court (location)  Colorado Bureau of Investigation  Other 4. If the Petition pertains to a dismissal that is not the result of the completion of a deferred judgment and sentence or a multiple case disposition the Court shall grant the Petition without a hearing if the Petition is sufficient on its face. If the circumstances do not apply and the Court orders a hearing, the Court may grant the Petition if the Court finds that the harm to the Person in Interest’s privacy or the danger of unwarranted JDF 417 R2/18 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 1 of 3 adverse consequences outweighs the public interest in retaining the records. Explain why you believe the harm/danger outweighs the public interest. 5. COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW IF CHARGES WERE FILED OR IF NO CHARGES WERE FILED BUT THE PERSON IN INTEREST SUCCESSFULLY COMPLETED A DIVERSION AGREEMENT PURSUANT TO § 18-1.3-101, C.R.S. i. Complete the first five columns of the table below for all records the Person in Interest is asking the Court to seal. ii. Indicate in the Dismissal column by Yes or No whether each charge has been dismissed. If a charge was dismissed as part of a plea agreement in a separate case, the Petitioner must also complete Section 7e below. iii. Deferred: If the charge was dismissed as a result of completion of a deferred judgment and sentence, indicate Yes in the Deferred Judgment column. iv. Diversion: If the Person in Interest successfully completed a diversion agreement, indicate Yes in the Diversion Agreement column. If no charges were filed, indicate None in the Charges column. If a charge was filed but dismissed, list the charge in the Charge column and indicate Yes in the Dismissal Column. v. If the Person in Interest was acquitted, indicate Yes in the Acquittal column. Offense Date Arrest Date Arrest or Summons Number Charge (if any) F/M * Dismissal Deferred Judgment Diversion Agreement Acquittal * F/M asks Petitioner to state if Person in Interest’s records are related to Felony (F) or Misdemeanor (M) charges. 6. COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW, IF ARREST RECORDS EXIST, NO CHARGES WERE FILED, AND THE PERSON IN INTEREST DID NOT SUCCESSFULLY COMPLETE A DIVERSION AGREEMENT PURSUANT TO § 18-1.3.101, C.R.S. i. The Person in Interest may only ask the Court to seal the arrest records if and the statute of limitations for the offense for which the person was arrested that has the longest statute of limitations has run OR the statute of limitations has not run, but the Person in Interest is no longer being investigated by law enforcement for the commission of the offense. ii. If charges were not filed due to a plea agreement in a separate case, The Court cannot grant a request to seal the arrest record(s) for such offense(s). Date of Arrest Original Arrest Number Offense 7. Complete this section if the following court case exists but was dismissed due to a plea agreement in a separate case, ten years have passed since the final disposition of all criminal proceedings against the Person in Interest and Petitioner is not aware of any charges for any criminal offense against the Person in Interest during that ten-year period. Case Number of Case Dismissed Date Case was Dismissed Case Number(s) Identified in the Plea Agreement JDF 417 R2/18 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 2 of 3 JDF 417 R2/18 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 3 of 3 8. Court case numbers and criminal justice agency case numbers: County Court case number: District Court case number: Municipal Court case number: Law Enforcement Agency case number: Arrest number (from fingerprint card): Date: 9. The Person in Interest has paid all restitution, fines, court costs, late fines or other fees ordered by the Court, unless the Court has vacated the Order in the case requesting to be sealed. 10. The record does not pertain to a class 1 or a class 2 misdemeanor traffic offense. 11. The record does not pertain to a class A or a class B traffic infraction. 12. The record does not pertain to a deferred judgment and sentence for Driving Under the Influence (DUI), Driving while Ability Impaired (DWAI), or DUI per-se pursuant to § 42-4-1301(1) or (2), C.R.S. 13. The record does not pertain to a deferred judgment and sentence for an offense concerning the holder of a commercial driver’s license, or the operator of a commercial motor vehicle pursuant to § 42-2-402, C.R.S. 14. The record does not pertain to a deferred judgment and sentence for an offense for which the factual basis involved unlawful sexual behavior pursuant to § 16-22-102(9), C.R.S. 15. The decision not to charge an offense was not due to a plea agreement in a separate case. 16. Petitioner requests the Court to set a date for hearing on this Petition, if necessary, and to enter an order sealing arrest and criminal records pertaining to the Person in Interest, pursuant to § 24-72-702(1)(b)(II), C.R.S. and to seal this civil action.  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 Signature of Petitioner Date JDF 417 R2/18 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 4 of 3