Fill and Sign the Petition for Expungement Filed in a Circuit Court Pursuant to Form

SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 1 of 8 INSTRUCTIONS PETITION FOR EXPUNGEMEN T OF CRIMINAL RECORDS PROVIDED UNDER W.VA. CODE § 61-11-26 Petition Form Carefully read the attached form to fill out your Petition for Expungement of Criminal Records Provided Under W.Va. Code § 61-11-26. All of the statements included on the Petition form must apply to you, and must be true, in order for you to be eligible for expungement under this Code section. At any subsequent hearing on you r petition, you will have the burden of proof to demonstrate by clear and convincin g evidence that the statements you provide on the Petition are true. Legibly print or type your answ ers in the blanks provided for the caption (title) section and numbers 1 – 2 on the provided form. Statements numbered 5 through 5g deal with specific offenses which are not be eligible for expungement. Note that all of the statements in the Petition must be true in your case in order for you to be eligible to Petit ion the Court for expungement. Also note that from the time you file your Petition and while the Petition is pendin g, you cannot be arrested or made subject to any pending criminal proceeding to stay elig ible for expungement under this Petition. Check your responses to 1 – 5g, sign the Petiti on, and move on to the Verification portion. Verification Form Legibly print or type your answers to fill in the blanks on numbers 1 – 6 of the Verification portion of the form. Check the appropriate box to answ er number 7, and if you answered “yes,” attach the requested copy of the Order(s) described. Legibly print or type your an swers to numbers 8 through 10, a nd check the appropriate box for your answer to number 11, and attach any supporting documentation as de scribed in number 12. Certificate of Service Portion Fill out the caption (title) portion of the Certificate of Service, and indicate the boxes next to all applicable recipients, legibly pr inting or typing the appropriate addresses, and make as many copies of your petition and all attached documentation as necessary to serve all parties by the method you indicate. Under W.Va. Code § 61-11-26( e), any of the parties you serve may file a notice of opposition to the Court. If this should happen, you will be notified and will then have ten (10) days of being serv ed of such notice to reply. SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 2 of 8 IN THE CIRCUIT COURT OF __ _________________________ COUNTY, WEST VIRGINIA IN RE: EXPUNGEMENT OF RECO RD OF: CIRCUIT COURT NO.__________ ____________________________________ LOWER COURT NO. __________ (Full Name of Petitioner) PETITION FOR EXPUNGEMEN T OF CRIMINAL RECORDS AS PROVIDED UNDER W.VA. CODE § 61-11-26 Comes now the petitioner, pro se, and in support of his or her Petition for Expungement of Criminal Record does hereby allege and state as follows: 1. That on _____________________________, the petitione r was convicted of the (Date of conviction) misdemeanor offense(s) of ______________________________________________ which was/ (Misdemeanor conviction offense) were assigned case number(s) _____________________________. This paragraph includes all misdemeanor offenses and offenses arising from the same transaction. 2. That on, _____________________________, I, __________________________ (Date(s) of commission of offense(s)) (Petitioner’s Name) born on ______________________________, was between eighteen and twenty-six (Date of birth) years of age. 3. I, ______________________________, have no prior or s ubsequent convictions (Petitioner’s name) other than minor traffic violati ons at the time of this filing. SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 3 of 8 4. That one year has passed since the a bove listed and described conviction or completion of petitioner’s senten ce of incarceration or probation, whichever happened later in time. The applicable date is ___________________________________. 5. I allege and state that the above-not ed charge(s) are eligible for expungement under this statute, because they do not involve any of the criteria that would render them ineligible under W.Va. Code § 61-11-26(i), including 5a. any violation involving the affliction of serious injury; 5b. any violation involving the provi sions of W.Va. Code § 61-8B-1, et.seq. where petitioner was eighteen (18) or older and the victim was twelve (12) or younger at the time the violation occurred; 5c. the use or exhibition of a dead ly weapon or dangerous instrument 5d. any violation of W.Va. C ode § 61-2-9(b) or (c) where the victim was a spouse, a person with whom the petitioner had a child in common or with whom the petitioner ever cohabitated prior to the offense 5e. any violation of W.Va. Code § 61-2-28 5f. a conviction for driving under the influen ce of alcohol or controlled substances, 5g. any violation of W.Va. Code § 17B-4-3 or W.Va. Code § 61-8-19. Wherefore, pursuant to W.Va. Code § 61- 11-26 (2009), and subject to the attached verification and information, the petitioner respectfully requests that this Honorable Court expunge the conviction(s) and the re cords associated therewith. _____________________________________________ Signature of petitioner SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 4 of 8 VERIFICATION I, ________________________________, verify the above and foregoing under oath, and include the following as require d under W.Va. Code § 61-11-26: 1. All petitioner’s names, current and previous: __________________________________________________________________ 2. All petitioner’s addresses, in order, from the date of offense to current: ______________________________________________________________________________________________________________________________________________________________________________________________________ 3. Date of birth: ______________________ / Social Security No. ______________ 4. Date of arrest: __________________________________ Court of jurisdiction: ________________________________________________ Complaint, indictment, su mmons or case no.: __________________________________________________________________ 5. Statute and offense(s) of conviction(s): ________________________________________________________________________________________________________________________________________________________________________________________________ 6. Name(s) of victim(s), or statement of no identifiable victim(s): __________________________________________________________________ __________________________________________________________________ SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 5 of 8 7. Is there a current order for restitution, protection, restraining order or other no contact order prohibiting the petitioner from contacting victim(s)?  Yes. (If yes, attach copy of order to this petition)  No Was there a prior order for restitution, protection, restraining order or other no contact order prohibiting the petitioner from victim(s)?  Yes (If yes, attach a copy of order to this petition)  No 8. The Court’s disposition of the matter, and punishment imposed, if any, was: ____________________________________________________________________________________________________________________________________ __________________________________________________________________ 9. Statement of reason for expungement reque st (ex. – employment or licensure purposes) and why it should be granted: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 6 of 8 10. Statement of steps petitio ner has taken since the time of the offense toward personal rehabilitation, such as treatment , work, or other personal history that demonstrates rehabilitation: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 11. Has petitioner ever been granted exp ungement or similar relief regarding a criminal conviction by any court in this stat e, in any other state, or by any federal court?  Y es  No 12. I have attached any suppor ting documentation, sworn statements, affidavits, or other information supporting the petition to expunge. Wherefore, pursuant to W.Va. Code § 61-11- 26 (2009), I, the Petitioner, verify under oath that the foregoing is true in support of my Petition for Expungement of Criminal Records as Provided under W.Va. Code § 61-11-26. _________________________________________ Petitioner’s Signature SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 7 of 8 IN THE CIRCUIT COURT OF __ _________________________ COUNTY, WEST VIRGINIA IN RE: EXPUNGEMENT OF RECO RD OF: CIRCUIT COURT NO.__________ ____________________________________ LOWER COURT NO. __________ (Full Name of Petitioner) CERTIFICATE OF SERVICE I do hereby certify that I have th is day given a true and correct copy of the foregoing Petition For Expungement Of Criminal Records as Provided Under W.Va. Code § 61-11-26 and all attached supporting documentation to:  The Superintendent of the State Police, at ________________________________________________________________________  The ____________________________ County Prosecuting Attorney Office, at ________________________________________________________________________  The Chief of Police (or other Executive Head of the Municipal Police Department where the Offense(s) were Committed, at ________________________________________________________________________  The Chief Law Enforcement Officer of any other Law Enforcement Agency which participated in the arre st (if applicable), at _______________________________________________________________________  The Superintendent or Warden of any Inst itution in which Petitioner was confined (if applicable) at ________________________________________________________________________ SCA-C900 Rev. 04/2010 Petition for Expungement of Criminal Reco rds Provided Under W.Va. Code § 61-11-26 Docket Code(s): CMPEX Page 8 of 8  The Magistrate Court or Muni cipal Court which Disposed of the Criminal Charge at ________________________________________________________________________  All other state and local government agenci es whose records would be affected by an expungement (if applicable) at ________________________________________________________________________ by the following method: ฀ First Class Mail ฀ Hand Delivery ฀ Certified Mail – Return Receipt Dated: ______________________________________________________ ____________________________________________________________ (Signature of Petitioner)