Fill and Sign the Entry Granting Application for Expungement and Sealing of Form

_________________ COUNTY _________________ COURT Criminal Division _________________ County, Ohio___________________________ CASE NO. _________________ IN RE: THE APPLICATION OF APPLICATION FOR ENTRY SEALING RECORD OF ARREST (NON- CONVICTION) RECORD PURSUANT TO R.C. 2953.52 ___________________________ COMES NOW the Petitioner seeking An Order Sealing Record of Arrest (Non- Conviction) pursuant to Ohio Revised Code §2953.52 and respectfully states under oath as follows: A. Preliminary Facts 1. Petitioner's:Full Name: Name used at time of arrest: Sex: Male FemaleRace: Date of Birth: (day/month/year)Driver's License Number: Social Security Number: 2. The offense charged against the Petitioner: 3.The date the offense charged against the Petitioner was alleged to have been committed: (day/month/year)4.The date the Petitioner was arrested: (day/month/year)5.The name of the county where the Petitioner was arrested and if the arrest occurred in a municipality, the name of the municipality: County Municipality (if applicable);6.The name of the agency that arrested the Petitioner: 7. The case number and court of offense: Case No: Court: 8. Final disposition of the criminal charge was on: (day/month/year) B. Basis for Expunction 1.Petitioner is eligible for expungement of convictions and/or criminal records under the provisions of: R.C. § 2953.52(A)(1) in that the Petitioner was found not guilty of the offense by a jury or a court, or was named in a dismissed complaint, indictment, or information. OR R.C. § 2953.52(A)(2) in that the grand jury entered a no bill. 2.Final action (dismissal, finding of no bill, or acquittal) was entered on . 3.The Petitioner would further show that interests of the applicant in having the records pertaining to his conviction sealed are not outweighed by any legitimate governmental needs to maintain such records.3.Petitioner would suggest that it would best serve the interest of justice that this motion be sustained and that the maintenance of records of the Petitioner’s arrest and disposition of this cause would serve no function as a police investigative tool; and that the maintenance of said police records would invade the Defendant's right to privacy, due process and equal protection. _____________________________________________ Signature of Petitioner Print Full Name STATE OF COUNTY OF This instrument was acknowledged to me on _________________ (date) by _________________ (name). _____________________________________Notary Public, State of My Commission expires _________________ COUNTY _______________ COURT Criminal Division ______________ County, Ohio___________________________ CASE NO. _____________ IN RE: THE APPLICATION OF ENTRY SEALING RECORD OF ARREST (NON-CONVICTION) PURSUANT TO R.C. 2953.52 ___________________________ This matter came before the Court on the application of the above named individual. Upon conclusion of the hearing heard on _____________________, the Court finds the following:That the person was not convicted in the case; that no criminal proceedings are pending against the person; and the interests of the person in having the records pertaining to the case sealed are not outweighed by any legitimate governmental needs to maintain such records.Therefore, it is hereby ordered that all official records pertaining to this case shall be sealed, and except as provided in Revised Code Section 2953.53, all indexed references thereto shall be deleted, that the proceedings in said case shall be deemed not to have occurred, and that the applicant's record of arrest and non-conviction shall be sealed, subject to the exceptions set forth in Revised Code 2953.53 and 2953.54 as now enacted and as hereinafter amended.It is further ordered that copies of this entry shall be served by the Clerk of Courts on the following:1.The law enforcement official in charge of the agency or organization which caused the applicant's arrest;2.The head of the prosecuting agency which prosecuted the case;3.The _________ County _________ Court Probation Department;4.The Bureau of Criminal Investigation in the Office of the Attorney General of the State of Ohio; 5.The Regional Computer Center (RCC), Cincinnati, Ohio;6.The Assignment Commissioner of the _________ County Municipal Court;7.The Chief Court Reporter of the _________ County Municipal Court.It is further ordered that the Clerk of this Court and the persons named above shall not use said records nor permit the inspection or use of said records except as provided in Revised Code Sections 2953.53 and 2953.54 as now enacted and as hereinafter amended.__________________________________ ____________________________ ______(Attorney for Applicant) or Judge, ___________ County(Applicant Pro Se)___________ Court__________________________________ ____________________________ _________________ ProsecutorDate ADDITIONAL INFORMATION RECORDFor purposes of identification of the record to be sealed, the following information willbe provided to arresting agencies and any and all known custodians of arrest andconviction records:This information must be filled out to the best of your knowledge. Please print allinformation.1. Applicant’s full name _______________________2. Applicant’s maiden name _______________________3. Applicant’s full address _______________________4. Applicant’s Gender_______________________ Applicant’s Race _______________________5. Applicant’s date of birth _______________________6. Court Case Number _______________________7. Charge at Arrest _______________________8. Charge CONVICTED of _______________________9. Ohio BCI Number (if known) _______________________10.FBI Number (if known) _______________________11.Social Security Number _______________________