Fill and Sign the Hearing Adjudication Form

District County Court _______________________County, Colorado Court Address: People of the State of Colorado v. Defendant COURT USE ONLY Case Number: Division: Courtroom: ORDER TO SEAL CRIMINAL JUSTICE RECORDS PURSUANT TO §24-72-702.5, C.R.S. The Court has considered Defendant’s motion to seal criminal justice records pursuant to § 24-72-702.5, C.R.S. and has examined the record. The Court finds Defendant is eligible for relief under § 24-72-702.5, C.R.S. Defendant’s Name: Date of Birth: Current Mailing Address: City: _________ ______ State: Zip Code: The Court ORDERS that the criminal records information specifically relating to and contained in: County Court case number: ________ District Court case number: _______ Law Enforcement Agency case number: Arrest number (from fingerprint card): Date: Colorado Bureau of Investigation (Statute authorizes this agency to assess an additional fee to seal its records.) shall be sealed immediately, except for basic identifying information, and that upon inquiry in the matter, the Person in Interest and criminal justice agencies to which this Order is directed may properly reply that no such records exist with respect to such person. The Court directs the above Order to the Clerk of Court to seal the criminal case listed above. Copies of this Order shall be provided, as evidenced by the attached Certificate of Mailing, to each custodian who may have custody of any of the records subject to this Order. Date: Judge JDF 478 R9/2017 ORDER TO SEAL CRIMINAL JUSTICE RECORDS, PURSUANT TO §24-72-702.5, C.R.S. © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 CERTIFICATE OF MAILING I certify that on ________________________ (date), I delivered a copy of this Order to the following:  Petitioner and/or  Petitioner’s Attorney:  Hand-Delivered,  E-filed, or  Mailed to:  Sheriff’s Department  District Attorney  Law Enforcement Agency  Colorado Bureau of Investigation 690 Kipling St., Suite 3000, Attn: Identification- Seals. Lakewood, CO 80215  Other ____________________:  Hand-Delivered,  E-filed, or  Mailed to: __________________________________________________________________________________ __________________________________________________________________________________ Clerk signature:______________________________________ JDF 478 R9/2017 ORDER TO SEAL CRIMINAL JUSTICE RECORDS, PURSUANT TO §24-72-702.5, C.R.S. © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 2