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GEORGIA BUREAU OF INVESTIGATION GEORGIA CRIME INFORMATION CENTER AGENCY INSTRUCTIONS FOR REQUEST TO RE STRICT (EXPUNGE) ARREST RECORD f or Arrests Prior to 07/01/2013 1. O.C.G.A. §35 -3-37 provides for the restriction of certain criminal history records for non -criminal justice purposes when approved by the prosecuting attorney.  For arrests prior to July 1, 2013 the applicant is required to apply for restriction at the arresting agency. Arresting agencies may require a processing fee not to exceed $50.00 as authorized per §35 -3-37 .  The REQUEST TO RESTRICT ARREST RECORD is a three section (page) form.  Section One is completed by the applicant. Each request form may contain only one (1) Date of Arrest (there may be multiple charges for that arrest).  Section Tw o is completed by the arresting agency. The entire form is forwarded to the prosecutor for approval/denial.  Section Three is completed by the prosecutor. If approved, the prosecutor may enter the appropriate disposition restriction code using the GCIC CC H User Interface and notify the applicant that the restriction is complete. The arresting agency will receive a notification from GCIC that the record has been restricted. If the prosecutor enters the restriction in the CCH User Interface the application and fee should not be forwarded to GCIC.  If the prosecutor does not have access to the CCH User Interface, the application may be returned to the arresting agency.  The arresting agency should advise the applicant to forward the approved application to GCIC including the GCIC processing fee. Incomplete applications or those missing the required fee will not be processed and will be returned to the applicant. Do not forward the restriction application to GCIC if the request is denied by the prosecutor.  Appl icants may send the approved Request to Restrict Arrest Record form and $25.00 fee (money order or certified check payable to “Georgia Bureau of Investigation”) to: Georgia Crime Information Center Record Restrictions P.O. Box 370808 Decatur, Georgia 3 0037 -0808  GCIC will send a letter to the street address listed on Page 1 of the application when the restriction has been applied to the Georgia criminal history. 2. For arrests occurring July 1, 2013 or later, there is no application process. The prosecutor may approve the restriction at the time of sentencing. If restriction is approved upon sentence completion, it should b e noted in the sentencing documentation forwarded to the court. 3. When the restriction has been applied to the Georgia criminal history, access to that specific arrest cycle is restricted for non -criminal justice purposes (Employment/Licensing). However, su ch information may be available through other sources. GCIC has no control over information provided by local agencies or private vendors. Record Restriction Form Page 1 of 3 Effective Date: 07/01/2013 REQUEST TO RESTRICT ARREST RECORD Prior to 07/01/2013 O.C.G.A. §35 -3-37 One (1) Date of Arrest per Request SECTION ONE - APPLICANT INFORMATION (Completed by Applicant) Name: _______________________________________________________________________________ Date of Birth: _____________________________ Race: ___________________ Sex: ________________ Social Security Number: _________________________________________________________________ Telephone Number: _____________________ Email: ________________________ _________________ Street Address: ________________________________________________________________________ City: _______________________________________ State: _________________ Zip Code: ___________ Arresting Agency: ___________________________________ ___________________________________ Date of Arrest: ________________________________________________________________________ Offenses(s) Arrested For: ________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Sections One and Two of this form must be completed in their entirety before reque st may be submitted to the Prosecuting Attorney’s Office. I request the arrest record information (Date of Arrest and associated charges) described above pertaining to me be restricted from the record(s) of the arresting agency pursuant to the provisions of O.C.G.A. §35 -3-37. Signature : _________________________________________________ Date: ______________________ GBI Use Only Money Order _____________ Certified Check ____________ GBI Reference #____________ _ Record Restriction Form Page 2 of 3 Effective Date: 07/01/2013 SECTION TWO - ARREST INFORMATION (Completed by Arresting Agency) Date Request Received: ______________________________________________ ___________________ Applicant’s State Identification Number (SID): GA _____________________________________________ Offender Tracking Number (OTN): _________________________________________________________ Arresting Agency Name: _________________________________________________________________ Arresting Agency ORI Number: ____________________________________________________________ Case / Citation / Docket Number: __________________________________________________________ Date of Arrest: _________________________________________________________________________ Arrest appears on Georgia and/or FBI criminal history record? Yes No If arrest does not appear on either state or federal record, the record restriction cannot be processed. Arrest Charge Tracking Number(s) and Charges: ______________________________________________________________________________________ ______________________________________________________________________________________ Disposition of Arrest: ______________________________________________________________________________________ ______________________________________________________________________________________ Disposition appears on Georgia criminal history record? Yes No If No, attach official documentation containing disposition information. If official documentation is not available, please provide explanation and request for exception in Prosecutor’s Comments, e.g., No Further Action Anticipated. (Without a disposition on file, o fficial documentation, or g., No Further Action Anticipated. (Without a disposition on file, official documentation, or request for exception, this request cannot be processed.) Prosecuting Attorney/Court Case Referred To: ______________________________ __________________ Official Completing Form: Title: _______________________________ Name: ______________________________________ Telephone Number: ____________________ Signature: ______________________________________ Email: _____________________________ Record Restriction Form Page 3 of 3 Effective Date: 07/01/2013 SECTION THREE – PROSECUTING ATTORNEY (Completed by Prosecuting Attorney) Date Request Received: ___________________________________________________________ Judicial Circuit / County: _________________________________________________________ Prosecuting Agency ORI Number: _________________________________________________ District Attorney / Solicitor General: ________________________________________________ Prosecutor Assigned to Cas e: ____________________________________________________ Case / Citation / Docket Number: __________________________________________________ Please select one of the following actions: ______ Approved - Record Restriction Meets Statutory Requirements ______ No Information Available; Record Restriction Forwarded Without Objection ______ Approved - No Further Action Anticipated ______ No Information Available at Prosecutor’s Office; Returned to Arresting Agency for Further Research. DO NOT FORWARD RESTRICTION FORM TO GCIC. ______ Denied - Restriction Does Not Meet Statutory Requirements DO NOT FORWARD RESTRICTION FORM TO GCIC. If additional Charges from same Arrest Date, other than those identified on Page 2, are also approved for record restriction, list the Arrest Charge Tracking Number(s) and Charges in Prosecutor Comments. Prosecutor Comments: _____________________________________________________________________________ ___________________________________________________________ __________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Prosecutor Completing Form: Name: _____________________________________ Telephone Number: ______________ Signature: __________________________________ Email: _________________________