Fill and Sign the Get the 16 90 905 This Petition to Seal Form Has Been

Pursuant to A.C.A. § 16-90-905, this Order to Seal form has been adop\ ted and provided by ACIC. Arkansas law mandates the use of this form by all petitioners and by all Cir\ cuit and District Courts in the state of Arkansas. In the Court of , Arkansas Division State of Arkansas VS. (first, middle and last name) Case No. Order to Seal Now on this day of , the Court having examined the petition to seal and other matters , day of ,, and charged with the offense(s) of presented, finds that the defendant was arrested on the , A.C.A. § and that the defendant was found: (Please complete the appropriate section: A and/or B) Section A , A.C.A. § Guilty of , and was sentenced to , on the day of , The Court further finds that the defendant was sentenced under the provi\ sions of A.C.A. § , which provides for the sealing of a defendant's record. The Court now finds that the defendant has satisfactorily complied with \ the orders of this Court, that the defendant has been rehabilitate and the petition to seal the record of the offense(s) should be grante\ d. Section B Date of Final Disposition Dismissed Acquitted at Trial Case Not Filed Nolle Prossed Transferred to Juvenile Court Governor's Pardon / Other (if marked, please provide original circuit court disposition, if appli\ cable) Reason Offense (s) The Court now finds that under authority of A.C.A. § 16-90-906, which\ provides for the sealing of a defendant's records, the petition to seal the record of the offense(s) should be granted. It is therefore considered, ordered and adjudged that the following offe\ nse(s) in this case be sealed to all except those authorized by law to have access: The Court Clerk is directed to mail a copy of this order to the Arkansas\ Crime Information Center, to the Administrative Office of the Courts, to the arresting agency, and to the prosecuting attorney, who sh\ all seal all records maintained by them relating to the offense(s). Signature of Judge Type and print name of Judge The following information is required for proper identification of the defendant in the state and national record systems: Race Sex DOB Arrest Tracking No. SID No. FBI No. (if Known) (if Known) ACIC Order-Seal.Doc 02/27/08