Fill and Sign the Petition to Seal Arrest and Criminal Records Form

JDF 417 R 8/19 PETITION TO SEAL ARREST AND CRIMINAL RECORDS W HEN NOT CHARGES FILED PURSUANT TO §24 -72 -704, C.R.S. Page 1 of 3 District Court _________________________ County, Colorado Court Address: Petition of: Person in Interest (Primary subject of the criminal justice record) COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION TO SEAL ARREST AND CRIMINAL RECORDS WHEN NO CHARGES FILED PURSUANT TO §24 -72 -70 4, C.R.S. 1. The Petitioner is: (check one only) ❑ the Person in Interest that is the primary subject of the criminal justice record. ❑ the designated representative of the Person in Interest , by power of attorney or notarized authorization . ❑ the parent of the Person in Interest , if the P erson in Interest is under legal disability . ❑ the appointed legal representative of the Person in Interest , if Person in Interest is under legal disability . 2. Information about the Person in Interest : Date of Birth: Current Mailing Address: City : State: Zip Code : Home Phone #: Work Phone #: Cell #: 3. The Petitioner asks this Court for an Order to Seal Arrest and Criminal Records information in the custody of the following agencies: ❑ Sheriff’s Department ❑ District Attorney ❑ Law Enforcement Agency (name of agency) ❑ Municipal Court (location)  Colorado Bureau of Investigation ❑ Other 4. COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW IF CHARGES W ERE FILED OR IF NO CHARGES W ERE FILED BUT THE PERSON IN INTEREST SUCCESSFULLY COMPLETED A DIVERSION AGREEMENT PURSUANT TO § 18 -1.3 -101, C.R.S. i. Complete the first five columns of the table below for all records the Person in Interest is asking the Court to seal. ii. Deferred: If the charge w as dismissed as a result of completion of a deferred judgment and sentence , indicate Yes in the Deferred Judgment column . Offense Date Arrest Date Arrest or Summons Number F/M * Deferred Judgment * F/M asks Petitioner to state if Person in Interest’s records are related to Felony (F) or Misdemeanor (M) charges. JDF 417 R 8/19 PETITION TO SEAL ARREST AND CRIMINAL RECORDS W HEN NOT CHARGES FILED PURSUANT TO §24 -72 -704, C.R.S. Page 2 of 3 5. COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW, IF ARREST RECORDS EXIST, NO CHARGES WERE FILED, AND THE PERSON IN INTEREST DID NOT SUCCESSFULLY COMPLETE A DIVERSION AGREEMENT PURSUANT TO § 18 -1.3.101, C.R.S. i. The Person in Interest may only ask the Court to seal the arrest records if and the statute of limitati ons for the offense for which the person was arrested that has the longest statute of limitations has run OR the statute of limitations has not run , but the Person in Interest is no longer being investigate d by law enforcement for the commission of the offense . Date of Arrest Original Arrest Number Offense 6. Criminal justice agency case numbers: Law Enforcement Agency case number: Arrest number (from fingerprint card): Date: 7. Petitioner requests the Court to set a date for hearing on this Petition and to enter an order sealing arrest and criminal records pertaining to the Person in Interest , pursuant to § 24 -72 -70 4(1)( c)(II), C.R.S. ❑ By checking this box, I am acknowledging I am fillin g in the blanks and not changing anything else on the form. ❑ By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE ___________________________ ____________ ____________________________________________ (Printed name of Petitioner) Signature of Petitioner Date _______________________ ____________ ___ Signature of Attorney Date