Fill and Sign the Motion for Expungement Pursuant to Pa Form

AOPC Form Updated Rev 7/1/19 Motion for Expungement Pursuant to Pa.R. J.C.P. 170 AND NOW, the movant avers the following and requests that this motion for expungement pursuant to Pa.R. J.C.P. 170 be granted for the reasons set forth below. JUVENILE INFORMATION Name of Juvenile: Date of Birth of Juvenile if known: Alias(es): CASE INFOR MATION Juvenile’s Case Docket Number, if any: Date of Arrest: Name of law enforcement agency that i nitiated the allegations: Re ference number of police report or written allegation and, if available, the juvenile offense tracking number (JOTN): List specific allegations or offenses to which the expungement order pertains and the disposition of the written allegation or petition (please attach additional sheet(s) of paper if necessary): PA Statute (Title) Section Subsect i on Statute Description Counts Grade Disposition Check the reason(s) and statutory authority for expunging or destroying the documents, fingerprints, or photographs: Written Allegation not approved by prosecution. The petition was dismissed by the court. Six months have elapsed since the final discharge of the juvenile from supervision under a consent decree and no proceeding seeking adjudication or conviction is pending. Six months have elapsed since the final discharge of the juvenile from supervision under informal adjustment and no proceeding seeking adjudication or conviction is pending. The juvenile has been discharged from court supervision pursuant to Rule 631 and five years have elapsed, the juvenile has not been convicted or adjudicated delinquent for a felony or misdemeanor, no court proceeding is pending seeking such conviction or adjudication and the delinquent act is not an act precluded from expungement pursuant to18 Pa. C.S. §9123(a.1). The attorney for the Commonwealth consents to the expungement. Other: List the agencies upon which certified copies of the court order shall be served: I, the undersigned movant, avers that the facts set forth in this motion are true and correct to the movant’s personal knowledge, information or belief . _________________________________ __________________ Signature of Movant Date In the Court of Common Pleas County of ________________ ____ Judicial District In the Interes t of: __________________ __ Docket N o: ___________________