Fill and Sign the Expungement of Criminal Records Ca Penal Code 12034 Pc Form

AOC-497.2 Doc. Code: PEXA Rev. 4-17Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 431.076; 431.079 PETITION FOR EXPUNGEMENT (FOR ACQUITTAL, DISMISSAL WITH PREJUDICE, OR FAILURE TO INDICT) lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE COMMONWEALTH OF KENTUCKY PLAINTIFF VS. ________________________________________________ NAME DEFENDANT ________________________________________________ ADDRESS_________________________________________________________________________________PHONE NUMBER Defendant’s Birthdate: _____________ Defendant’s SSN: ________________ Violation/Arrest Date: _____________Jail ID Number____________________________(optional) Comes now the Defendant herein and petitions the Court, pursuant to KRS 431.076, to expunge the following charges which were either acquitted, dismissed with prejudice, or did not result in indictment in the above-referenced case: CHARGE: ____________________________________ CHARGE: ___________________________________ CHARGE: ____________________________________ CHARGE: ___________________________________ CHARGE: ____________________________________ CHARGE: ___________________________________ In support of this Petition, the Defendant states as follows: (Check all that apply) 1. q At least sixty (60) days prior to �ling this petition, the Defendant was acquitted of the above-listed charge(s); or, q At least sixty (60) days prior to �ling this petition, the above-referenced charge(s) was/were dismissed with prejudice and said dismissal was NOT in exchange for a guilty plea to another offense; q The above listed felony charges originally �led in district court have not resulted in an indictment by the grand jury and twelve (12) months have elapsed since the date of the District Court decision to hold the matter to the grand jury. AND 2. q There are no current charges or proceedings pending in the above-styled case. The Defendant prays that this Petition for Expungement for Acquittal, Dismissal with Prejudice, or Failure to Indict be granted and that this Court enter an Order that the following agencies expunge any records in the agencies' custody regarding these charges: LIST AGENCIES AND ADDRESSES HERE: _____________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. NOTE: A SEPARATE PETITION MUST BE FILED FOR EACH CRIMINAL CASE AND THE CHARGE(S) MUST BE LISTED IN THIS MOTION FOR THE CHARGE(S) TO BE EXPUNGED. ADDITIONALLY, A COPY OF YOUR CURRENT EXPUNGEMENT CERTIFICATION MUST BE ATTACHED TO THIS PETITION. Case No. ____________________ Court ____________________ County ____________________ Division ____________________ ( ) AOC-497.2 Rev. 4-17 Case No. _________________________ Page 2 of 2 For Clerk Use Only This Petition for Expungement was sent on the ________ day of_____________________________, _____ to Defendant/ Petitioner or his/her Attorney; the County or Commo nwealth's Attorney, as appropriate; and, if the criminal charge(s) relates to the abuse or neglect of a child, to the CHFS. __________________________________________ __ Clerk By: ______________________________________D.C. Note: Defendant/Movant must sign this petition in the presence of a notary or the circuit court clerk so that the clerk can witness his/her signature. Date: _____________________, _______. ___________________________________________ Defendant/Petitioner Signature ORDER Having considered this Petition for Expungement: q the court hereby orders the circuit court clerk to set a date for an expungement hearing. q no hearing is required. _____________________________ _______________ Judge NOTIFICATION OF EXPUNGEMENT HEARING This case is set for a hearing on ________________________________, ______ at the hour of ____________ q a.m. q p.m. at the ________________________________ q District q Circuit Court. Dated this ________ day of ________________________________, _________. The County or Commonwealth's Attorney, as appropriate, may respond to this Petition. If the criminal charge(s) relates to the abuse or neglect of a child, the Of�ce of General Counsel of the Cabinet for Health and Family Services (CHFS) shall respond within twenty (20) days of receipt of this noti�cation if the CHFS has custody of records that re�ect that Defendant/Petitioner has been determined by the CHFS or by a court under KRS Chapter 620 to be a substantiated perpetrator of child abuse or neglect. ____________________ _________________________ Clerk By: ______________________________________D.C. Subscribed and sworn to before me by ________________________________________________________________ this _______ day of ______________________, _______. ____________________________________________ Notary/Clerk My commission expires: ___________________, _______ By: ____________________________________ D.C.