Fill and Sign the Pennsylvania Expungement of a Summary Offense Package for Pennsylvania Form

INSTRUCTIONS TO EXPUNGE A SUMMARY OFFENSE Expungement is the removal of an offense from your cr iminal record. While information about the expunged offense will no longer appear on background checks, law enforcem ent and the Courts may still access this information to determine your eligibility for alternative punishment programs and grade future offenses. The expungement process usually takes appr oximately 3-6 months to complete. If your petition is approved, a copy of the Expungement Order will be mailed to y ou at the address you li sted on the petition. To qualify, you must meet the following requirements: 2. You have not been arrested or prosecuted for any crime (including summary offenses) in any county in the five (5) years since being convicted of the offense you wish to expunge. To request expungement of a summary offense, please co mplete the attached Petition for Expungement, the top section of the attached order, and obtain a recent certified copy of your comp lete criminal record from the Pennsylvania State Police ( www.psp.state.pa.us ). (Your Petition may be rejected if not filled in completely) Include a filing fee of $15.00 to: (NO PERSONAL CHECKS) 1. You were convicted or pled guilty to the summary offense. CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVA NIA Common Pleas Docket No. _______________________ Vs. Date of Arrest/Cit ation: __________ _________________ _____________________________ ______________ Arresting Agency: _______ ________________________ Date of Birth: ___________ _____________________ OTN/Cita tion #: _________ ________________________ Soc. Sec. No.: _________- _________- ____________ MDJ Docke t No.: _______________________________ Eligible Charge(s): __________________ __________ MDJ Court #: __49 - _________________ ____________ Reason for Expungement: Pursuant to 18 PA.C.S.A. 9122(b)(3)(i) Date of Conviction/Guilty Plea: __________________ The Document to which this certification is attached is a full, true, and correct copy of the original on file and of record in my office. ATTEST:____________________________ BY: __________________________________ DATE:_________________________ ORDER TO EXP UNGE SUMMARY OFFENSE AND NOW, this ______ day of __________________, 20_____, upon approval of the Distri ct Attorney or after a hearing on the matter, it appears to th e Court that the Defendant satisfactorily met r equirements listed by 18 PA. C.S.A. 9122(b)(3)(i). I t is ordered that the summary o ffense of ________________________________ listed in the above docket be EXPUNGED. The Clerk of Courts shall serve a certified copy of this order upon the following agencies pertaining to the above captioned criminal proceeding: (1) PA Central Repository (2) Arresting Agency ______________________ __ (3) MDJ _________________ (4) Def./Atty. _____________________ (5) District Attorney (6) AOPC (7) Penn Dot (if Applicable) Expunged offenses shall be available for t he purposes listed in 18 PA.C.S.A. 9122(c), and that said keepers of such criminal records shall file with this Court an Affidavit stat ing that the mandated of th is order have been fulfilled. BY THE COURT: ______________________ ___________________ AFFIDAVIT OF EXPUNGEMENT This is to certify that the official arrest, criminal records, and other documents filed pertaining to the particular arrest or prosecution or both of the above named defendant in the above captioned criminal proceedings for the above listed summary offenses(s) which ar e in the custody and control of this office, have been expunged . DATE: _________________________ BY: __________________ ________________________ COURT OF COMMON PLEAS OF ______________ COUNTY, PENNSYLVANIA CRIMINAL DIVISION COMMONWEALTH OF : PENNSYLVANIA : : v. : Docket Numb er: __________________ ____________________ : : _____________________________ : Defendant/Petitioner (your name). : PETITION TO EXPUNGE RECORD OF SUMMARY OFFENSE AND NOW, the Defendant, __________________ _____________________, petit ions this Honorable court to expunge the records in the above captioned action. In support of this request, Defendant attest s to the truthfulne ss of the following statements: 1. Petitioner resides at: (list comp lete address)_________________ ___________________________________________. 2. Petitioner was arrested by __________________________ ______________________ _______on _____/_____/_____. 3. Petitioner was charged with the followi ng summary offense: __ _____________________________ ________________. 4. Judge _______ __________________________ _____ entered Petitioner’s convicti on/guilty plea on _____/_____/____. 5. Certified records of the above listed action include but are not limited to, fingerprints, photographs and reports which were made available to the District Attorney as well as the following agencies: (1) PA Central Repository (2) Arresting Agency (3) Magisterial District Judge (4 ) Penn Dot (if Appl icable) (5) Def./Atty. (6) AOPC 6. Petitioner has been free of arrest or prosecution for five (5) years following the conviction for the above stated offense. (Attach a recent Certified Record Check from the PA State Police) 7. Petitioner now wishes to be free of t he record for the above stated summary off ense because it may prejudice him/her in future employment opportunities. 8. The COMMONWEALTH has no compelling interest to maintain records of the above stated incident. Respectfully Submitted by : ______________________ ________________________ Defendant (sign here) APPROVAL OF THE DISTRI CT ATTORNEY TO EXPUNGE does not object. _____ District Attorney requests to have a hearing on this matter. _______ ______________________ _________ Signature of District Attorney COURT OF COMMON PLEAS OF _____________ COUNTY, PENNSYLVANIA _____ The ____________ County District Attorney’s Office reviewed the Petition for Expungement filed by Defendant and