Legal Expunction Form

LEGAL EXPUNCTION FORM

Petitioner Name:    Date of Birth:    Case Number:

Respondent (Prosecuting Authority / Agency):    Court:

RECITALS

WHEREAS, Petitioner was arrested, charged, and/or convicted in the matter identified above and seeks statutory relief to remove or seal records arising from that matter; and

WHEREAS, Petitioner asserts that Petitioner meets the eligibility requirements under applicable law for an expunction order and that granting the relief requested will restore Petitioner to the status permitted by law following expunction; and

WHEREAS, Respondent is the appropriate governmental party for service and notice in connection with this Petition and may rely on this Petition to review, respond, and appear for any hearing as required by law;

NOW, THEREFORE, Petitioner petitions the Court for the entry of an Order of Expunction and in support states as follows:

1. PETITION FOR EXPUNCTION

Petitioner requests an order directing all state and local agencies, courts, law enforcement agencies, prosecuting offices, criminal justice record repositories, and private entities maintaining criminal history or arrest records to seal, expunge, destroy, and/or restrict access to records that relate to the arrest, charge, conviction, or other disposition for the matter identified above, to the fullest extent permitted by applicable law.

2. DEFINITIONS

For purposes of this Petition: "Records" means all documents, electronic records, indices, automated databases, arrest logs, charging instruments, conviction registers, fingerprint cards, photographs, and other materials maintained by any public agency or private repository that directly identify or refer to Petitioner and the matter described in this Petition.

3. RELIEF REQUESTED — SPECIFIC RECORDS

Petitioner expressly requests that the Order include, where applicable, directives to: (a) seal or destroy court files and indexes; (b) remove or obliterate fingerprint and biological data; (c) notify criminal justice agencies and third-party repositories to correct or remove Petitioner from background check products; and (d) restore Petitioner to all rights and privileges lost as a result of the record, to the extent permitted by law.

4. GROUNDS FOR EXPUNCTION

Petitioner affirms under penalty of perjury that one or more of the following factual predicates for expunction apply (select all that apply and provide supporting explanation in the attached factual statement):

Conviction has been vacated, set aside, or otherwise rendered null and void.    Diversion or deferred adjudication successfully completed.    Arrest without formal charge or prosecution.    Statutory eligibility due to passage of required time period.

5. NOTICE, SERVICE, AND CONTACT INFORMATION

Certificate of Service: Petitioner certifies that a true and correct copy of this Petition and any attachments has been mailed or delivered to the Respondent at the address above on .

6. HEARING, EVIDENCE, AND BURDEN

Petitioner requests that the Court schedule a hearing on this Petition as required by law. Petitioner understands that the burden of proof is on Petitioner to establish eligibility and entitlement to relief by a preponderance of the evidence unless otherwise provided by statute. Petitioner may present certified court records, affidavits, and other admissible evidence in support of this Petition.

7. EFFECT OF ORDER

If granted, the requested Order shall: (a) direct all agencies and repositories to seal, destroy, or restrict access to Records as specified; (b) prohibit routine disclosure of the Records in consumer background checks or routine public access, except as expressly permitted by statute; (c) require agencies to notify other repositories within a reasonable time to effectuate the Order; and (d) permit disclosure to law enforcement or as required by statute for specified limited purposes only.

Petitioner acknowledges that certain statutory exceptions may permit limited disclosure notwithstanding expunction, and that expunction may not erase records in all federal or non-state databases beyond the control of Respondent.

8. FEES, COSTS AND ATTORNEY REPRESENTATION

Petitioner requests that court fees and costs, if applicable, be waived or taxed to the appropriate party as permitted by law. Petitioner states whether Petitioner is represented by counsel below.

Yes    No

9. CERTIFICATIONS, ACKNOWLEDGMENTS AND PENALTIES

Petitioner certifies under penalty of perjury that the information provided in this Petition and any attachments is true and correct to the best of Petitioner’s knowledge and belief. Petitioner acknowledges that false statements in connection with this Petition may subject Petitioner to sanctions or criminal penalties as provided by law.

10. MISCELLANEOUS PROVISIONS

Governing Law: This Petition and any Order entered hereunder shall be governed by the laws of the jurisdiction in which the Court sits.

Entire Agreement: This Petition, attachments, and any Court Order constitute the entire statement of relief requested by Petitioner and supersede all prior oral or written statements regarding the matters raised herein.

Severability: If any provision of this Petition is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments; Waiver; Counterparts: Any amendment to the Petition must be in writing. Waiver of any provision requires express written agreement. This document may be executed in counterparts and by electronic signature where permitted.

11. ATTACHMENTS

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