Fill and Sign the Expunge Juvenile Records Form

In the Juvenile Court of Utah __________ Judicial District ________________ County Court Address ______________________________________________________ In the interest of ____________________________________________ Name ____________________________________________ Address ____________________________________________ Phone Number ____________________________________________ Date of Birth Petition to Expunge Records _______________________________ Case Number _______________________________ Judge Parents’ Names: [ ] By and through my attorney (Check if an attorney will be representing you) Attorney Name Bar Number (You are not required to have an attorney represent you) Being first duly sworn, I say as follows: (Choose all that apply). (1) [ ] My full and correct name, the date and year of birth and the names of my parents are as set forth above. (2) [ ] I am 18 years of age OR [ ] I request that the judge waive the age requirement because: (3) [ ] The Juvenile Court jurisdiction and/or custody and parole supervision of the Division of Juvenile Justice Services (formerly Division of Youth Corrections) was unconditionally terminated at least one year ago. OR [ ] I request that the court waive the one-year requirement because: Petition to Expunge Records Approved Board of Juvenile Court Judges August 13, 2010 Revised May 9, 2017 Page 1 of 3 (4) [ ] Since my 18 th birthday, I have resided at the following address(es): (5) [ ] I have never been convicted of a felony level criminal offense or of a misdemeanor level offense involving moral turpitude and there is no pending felony level or misdemeanor level offense against me. (6) [ ] I have paid all fines, fees, restitution and interest. (7) [ ] The court and the following agencies may have records to be expunged: (8) [ ] The court and agencies may have related records under the following names, which I have used. (9) [ ] I am a responsible and law-abiding citizen of good moral character. (10) [ ] I request that the court order my juvenile court records expunged and related records in the possession or control of any state, county or local government agency expunged. I have not included any non-public information in this document. Sign here ► Date Typed or Printed Name On this date, I certify that _________________________________________________________ (name) who is known to me or who presented satisfactory identification, in the form of ______________________________________________________ (form of identification) , has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. Sign here ► Petition to Expunge Records Approved Board of Juvenile Court Judges August 13, 2010 Revised May 9, 2017 Page 2 of 3 Date Typed or printed name (Court Clerk or Notary Public) Notary Seal Petition to Expunge Records Approved Board of Juvenile Court Judges August 13, 2010 Revised May 9, 2017 Page 3 of 3