Fill and Sign the Page 2 of 8 How to Fill Form I 130 and I 130a Complete

APPLICATION FOR EXPUNGEMENT OF ARREST RECORDS You may leave blank the spaces on this form that call for your social security number and right thumbprint. There is presently no law or regulation that requires you to provide them. If you do provide your social security number, right thumbprint, or both, we will use them only to verify that th e correct arrest record is expunged, if you are entitled to an expungement under Hawaii Revised Statutes, Section 831-3.2. Current Name:________________________________________________________________ Sex: M____ F____ (Last, First, Middle) Other Names Used:______________________________________________ Date of Birth:_____________ Social Security Number:______________________________ Place of Birth:_________________________ _______________________________________________________________________________________ Home Address City State Zip Code Telephone Number In accordance with the provisions of Section 831-3.2, Hawaii Re vised Statutes, I hereby submit this application to have my arrest record expunged for the following alleged offense(s) for wh ich no conviction has been secured: Date of Place of Date of Last Offense Arrest Arrest Court Appearance __________________________________________ ___________ ____________________ ________________ __________________________________________ ___________ ____________________ ________________ __________________________________________ ___________ ____________________ ________________ If I am found to have no record of conviction, I also request the return of fingerprints and photographs. I hereby declare that I am not a fugitive from justice. Mailing Address for all correspondence: _______________________________________________ _______________________________________________ _______________________________________________ Date:___________________ Applicant’s Signature_____________________________________________ Fee Amount : First Time Applicant $35.00 All Others $50.00 Cash or Money Order made payable to State of Hawaii. NO PERSONAL OR BUSINESS CHECKS ACCEPTED Right Thumbprint Return application and money order to: Arrest Records Expunger Hawaii Criminal Justice Data Center Department of the Attorney General 465 S. King Street, Room 101 Honolulu, Hawaii 96813 HCJDC 159 (5/11/2009)