200-00132 – Stipulation to Expunge or Seal Criminal History Record + Order (09/2018) Page 1 of 1
STIPULATION TO EXPUNGE OR SEAL CRIMINAL HISTORY RECORD
We, the undersigned Defendant and State’s Attorney, hereby agree that the offense(s) meet the requirements
for expungement or sealing pursuant to 13 V.S.A. §7602 and that the Court may issue an Order to:
☐ Expunge
☐ Seal
the criminal history record for the offense(s) described below:
Description of Offense Date of Offense Incident Number Docket Number (if any)
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
☐ I was cited or arrested by (name of arresting law enforcement agency or department)
___________________________________________, but a charge was never filed with the Court.
We further understand that the effect of this Order will be to expunge or seal any records of arrest, conviction
or sentencing for this/these offense(s) and that the Defendant will hereafter be treated in all respects as if he
or she had never been arrested, convicted of sentenced for the offense(s).
Dated
_____________________________ _______________________________________
Signature of Defendant
_____________________________________
Signature of State’s Attorney
ORDER
Based upon the agreement of the Defendant and the State’s Attorney and pursuant to 13 V.S.A. §7602, it is
hereby ORDERED that criminal history record of the offense(s) described above be:
☐ Expunged
☐ Sealed
All records related to the arrest, conviction or sentencing for this/these offense(s) shall be expunged or sealed
and that the Defendant will hereafter be treated in all respects as if he or she had never been arrested,
convicted of sentenced for the offense(s).
Dated of Signature
_____________________________ _______________________________________
Signature of Superior Court Judge
_____________________________________
Printed Name of Judge
