Fill and Sign the Order for Expunction Form

File No. Name And Address Of Petitioner ORDER FOR EXPUNCTIONOF JUVENILE RECORD (UNDISCIPLINED/DELINQUENT) STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF Date Of Birth Date Of Adjudication Date Name Of Presiding Judge (type or print) Signature Of Presiding Judge Age G.S. 7B-3200 The Court, having found that the petitioner satis�ed the conditions set out in G.S. 7B-3200, ORDERS that the Clerk of Superior Court shall forward a certi�ed copy of this order to the Sheriff, Chief of Police, or other law enforcement agency having records referring to this petitioner as a juvenile, and to the chief court counselor, and such records of adjudication described below, including all references to arrest, complaints, referrals, petitions, and orders, shall be expunged by that agency or of�cial. Undisciplined Delinquent (name offense) Certi�ed copies of this order were forwarded to The Sheriff of County. The Chief of Police of . Other law enforcement agency. The Chief Court Counselor. NOTES TO CLERK: 1) Class A-E felonies are not eligible for expunction. Do not destroy Class A-E felony records within the juvenile’s �le. 2) As soon as practical after each term of court in your county, �le with the Records Of�cer of the Administrative Of�ce of the Courts the names of persons granted an expunction pursuant to G.S. 7B-3200 (Send a certi�ed copy of the Order For Expunction to Attn: Records Of�cer, Administrative Of�ce of the Courts, PO Box 2448, Raleigh, NC 27602, or to the same at Courier Box 56-10-50.). 3) Upon the expunction of the juvenile’s record, send written noti�cation to the “juvenile’s last known address informing the juvenile that the record has been expunged and with respect to the matter involved, the juvenile may not be held thereafter under any provision of any laws to be guilty of perjury or otherwise giving a false statement by reason of the juvenile’s failure to recite or acknowledge such record or response to any inquiry made of the juvenile for any purpose except that upon testifying in a delinquency proceeding, the juvenile may be required by a court to disclose that the juvenile was adjudicated delinquent.” G.S. 7B-3202. Signature Date Assistant CSC Clerk Of Superior Court Name Of Other Law Enforcement Agency NC-JOIN No. AOC-J-905, Rev. 12/17 © 2017 Administrative Of�ce of the Courts