Legal Misdemeanor Affidavit

LEGAL MISDEMEANOR AFFIDAVIT

State of:   County of:

Affiant Name:

Affiant Address:

Date of Birth:   Telephone:

RECITALS

WHEREAS, Affiant is an adult resident of the State of and has personal knowledge of the facts set forth in this affidavit; and

WHEREAS, Affiant was charged in with an offense described as on or about under case number .

WHEREAS, the disposition of that proceeding is set forth below and Affiant seeks to provide a sworn statement of the facts, disposition, and any rehabilitation or restitution completed since the disposition.

NOW, THEREFORE

Affiant certifies under oath, before a duly authorized official, that the following statements are true and correct to the best of Affiant's knowledge and belief:

1. IDENTIFICATION AND BACKGROUND

Full Legal Name:

Current Address:

2. STATEMENT OF FACTS

On at or near , Affiant was involved in the following events (narrative statement):

Arresting Agency:   Citation/Charge:

3. DISPOSITION

Case Number:   Court:

Disposition (check all that apply):

Convicted after trial     Pleaded guilty     Pleaded no contest

Dismissed     Reduced to lesser offense     Expunged/sealed

Date of Final Disposition:

Sentence Imposed (if any):

Restitution/Fines Paid (amount):   Probation/Parole Completed: Yes No

4. AFFIANT'S CERTIFICATION

Affiant affirms under penalty of perjury under the laws of the State of that the foregoing statements and attached factual narrative are true and correct to the best of Affiant's knowledge and belief.

Affiant understands that a material false statement in this affidavit may constitute the crime of perjury and may subject Affiant to criminal and civil penalties.

5. NOTICES AND INTENDED USE

This affidavit is provided to document the facts and disposition of a misdemeanor matter and may be relied upon by courts, licensing authorities, employers, or other entities that lawfully review affidavits. Affiant acknowledges that submission of this affidavit does not itself vacate or expunge any conviction; relief, if any, must be sought through the appropriate court process.

6. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

Governing Law: This affidavit shall be governed by and construed in accordance with the laws of the State of .

Severability: If any provision of this affidavit is held invalid or unenforceable, such invalidity shall not affect other provisions which can be given effect without the invalid provision, and to this end the provisions of this affidavit are severable.

Entire Agreement: This affidavit contains the entire sworn statement of Affiant regarding the matters set forth herein and supersedes any prior oral or written statements on the subject.

7. AMENDMENTS AND WAIVER

Amendments to this affidavit shall be made in writing and sworn to by Affiant. No waiver of any provision shall be effective unless in writing and signed by the party granting the waiver.

NOTARY ACKNOWLEDGMENT

On this day, before me, the undersigned Notary Public, personally appeared Affiant named above, who is known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this affidavit, and acknowledged that Affiant executed the same for the purposes stated herein.

County of Notarial Jurisdiction:   State:

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