Fill and Sign the Victims Statement for Expungement Request Utah Form

My Name Address City, State, Zip Phone Email I am the [ ] Victim of the crime being considered for expungement [ ] Attorney for the victim and my Utah Bar number is _________ [ ] Prosecuting Attorney and my Utah Bar number is _________ In the [ ] District [ ] Justice Court of Utah __________ Judicial District ________________ County Court Address ______________________________________________________ In Re Petition to Expunge the Records of ____________________________________ [ ] Victim’s Statement [ ] Prosecutor’s Statement _______________________________ Statement Approved Board of District Court Judges October, 2012 Revised April 7, 2015 Page 1 of 4 _ Petitioner Case Number _______________________________ Judge Attach additional pages as needed to complete paragraphs that don’t have enough space. Write the paragraph number on the additional page . [ ] By and through my attorney, (Attorney, check here if you are appearing for your client.) I say as follows: (1) I [ ] object [ ] do not object to expunging the petitioner’s records because: (Choose (2) if you have a recommendation and then choose the box(es) that describe your recommendation.) (2) [ ] I recommend that: [ ] The court should expunge the records. [ ] The court should not expunge the records. [ ] Other recommendation: Statement Approved Board of District Court Judges October, 2012 Revised April 7, 2015 Page 2 of 4 I have not included any non-public information in this document. I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true and correct. Sign here ► Date Typed or Printed Name Statement Approved Board of District Court Judges October, 2012 Revised April 7, 2015 Page 3 of 4 Certificate of Service I certify that I served a copy of this Statement by the [ ] Victim [ ] Prosecutor on the following people. Person’s Name Method of Service Served at this Address Served on this Date (Petitioner) [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) (Prosecutor) [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) (Victim) [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) (Clerk of Court) [ ] Mail [ ] Hand Delivery [ ] Electronic File Sign here ► Date Typed or Printed Name Statement Approved Board of District Court Judges October, 2012 Revised April 7, 2015 Page 4 of 4