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P
ETITION TO EXPUNGE OR SEAL CRIMINAL HISTORY
The above-named Defendant hereby requests that the Court order that his/her criminal history record be
expunged or sealed. As grounds for the request, Defendant hereby states as follows:
1. Charges: I am requesting that the criminal records for the following offense(s) be expunged or sealed:
Description of Offense Year Docket Number (If Any)
1. _______________________________________ ___________ ________________________
2. _______________________________________ ___________ ________________________
3. _______________________________________ ___________ ________________________
If more than one offense is listed, the offenses must relate to the same incident.
2. Record of Convictions:
☐ I was convicted of the offenses.
If you were convicted, please provide the following about your conviction:
a. Date of conviction: _______________________
b. I completed all of the conditions of my probation:
☐ Yes – Date of Completion: _____________
☐ No
c. Any restitution ordered by the Court has been paid:
☐ Yes
☐ No
☐ Restitution was not ordered
☐ I was not convicted for the offenses listed above.
If you were cited or arrested for the offense, but never convicted, answer the following questions and
then skip to question 3.
☐ I was cited or arrested, by (name of arresting law enforcement agency or department)
___________________________________________, but a charge was never filed with the Court.
☐ A charge was filed, but the Court did not find probable cause.
☐ A charge was filed and later dismissed by the Court.
3. List any new charges or convictions you have received since the date of the offense listed in question 1.
Offense Date of Offense Date of Charge Date of Conviction
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
4. I am requesting that my criminal history record be:
☐ Expunged (all records destroyed except order of expungement)
☐ Sealed (records maintained but under seal meaning they are not public)
200-00130 – Petition to Expunge or Seal Criminal History (11/2019)
