Fillable APPLICATION TO VACATE AND EXPUNGE FELONY CONVICTION COMMONWEALTH (Administrative Office of the Courts)

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APPLICATION TO VACATE AND EXPUNGE FELONY CONVICTION COMMONWEALTH (Administrative Office of the Courts)

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In support of this Application, the Defendant states as follows:
1. The Defendant was charged with or convicted of the oense(s) listed above.
2. The above-stated oense(s) is/are eligible to be vacated and expunged as follows: (check only one)
q the oense is one of the eligible oenses listed in KRS 431.073(1)(a).
q the oenses are a series of eligible oenses listed in KRS 431.073(1)(a) which arose from a single incident.
q a full pardon has been granted by the Governor, a copy of which is attached.
q the oense is an eligible oense under KRS 431.073(1)(d). (Must complete section 8 on page 2.)
q the oenses are a series of eligible oenses under KRS 431.073(1)(d). (Must complete section 8 on page 2.)
3. The Defendant has not, in the ve (5) years prior to the ling of this Application, been convicted of a felony or
misdemeanor.
4. No proceeding concerning a felony or misdemeanor is pending or being instituted against the Defendant.
5. This Application is led no sooner than ve (5) years after completion of the Defendant’s sentence or successful
completion of the Defendant’s probation or parole, whichever occurs later.
6. (Check one) q The Defendant has not had a felony conviction vacated and expunged under KRS 431.073.
OR
q The Defendant has had a felony conviction expunged under KRS 431.073 but it was prior
to June 28th, 2019.
APPLICATION TO VACATE AND
EXPUNGE FELONY CONVICTION
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AOC-496.3 Doc. Code: AFEX
Rev. 6-19
Page 1 of 3
Commonwealth of Kentucky
Court of Justice www.courts.ky.gov
KRS 431.073; 431.079
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
COMMONWEALTH OF KENTUCKY PLAINTIFF
VS.
________________________________________________ NAME DEFENDANT
________________________________________________ ADDRESS
________________________________________________
_________________________________PHONE NUMBER Jail ID Number ________________ (optional)
Defendant's Birthdate: ______________ Defendant's SSN: ______________ Violation/Arrest Date: _______________
( )
Comes now the Defendant herein and moves this Court, under KRS 431.073, to vacate the conviction and expunge the
following oense(s) in the above-referenced case: (
If requesting expungement of the entire case, then all charges must be
listed, including any non-felony charges. Attach additional sheet, if needed.)
CHARGE: _________________________________ CHARGE: _________________________________
CHARGE: _________________________________ CHARGE: _________________________________
CHARGE: _________________________________ CHARGE: _________________________________
(If the above-referenced case originated in district court, list the underlying district court case number(s) and charge(s) to
be expunged.)
CASE NO.: _________________________________
CHARGE: _________________________________ CHARGE: _________________________________
CHARGE: _________________________________ CHARGE: _________________________________
CHARGE: _________________________________ CHARGE: _________________________________
AOC-496.3
Rev. 6-19
Page 2 of 3
7. List the names of all victims of the crimes listed above (if known):
Victims: ______________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
8. (Complete this section only if applying for expungement under KRS 431.073(1)(d). *Attach additional sheets, if needed.)
a. Did you complete any rehabilitative activities/programs in prison? (such as, but not limited to, education, counseling,
alcohol or substance abuse programs, parenting classes, work programs) ______________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
b. Since you have been released, have you participated in any rehabilitative activities/programs? ______________
_________________________________________________________________________________________
_________________________________________________________________________________________
c. How have you changed since being convicted or released (if incarcerated)? _____________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
d. Give examples of how you have been living a law-abiding life since being convicted/released. _______________
_________________________________________________________________________________________
_________________________________________________________________________________________
e. What impact has a felony conviction had on your life? ______________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
f. If expungement is granted, how will this make a dierence in your life? _________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
g. Is there anything else you would like the Court to know as it considers whether to grant or deny this Application?
_________________________________________________________________________________________
_________________________________________________________________________________________
The Defendant moves that this Application to Vacate and Expunge a Felony Conviction be granted and that this Court enter
an Order that the Kentucky State Police, the Kentucky Department of Libraries and Archives, and the following agencies
expunge any records in the agencies' custody regarding these charges: LIST AGENCIES AND ADDRESSES HERE:
(Records may be held at multiple agencies. Please identify any government agency that may have a record of
your conviction such as, but not limited to, jail facilities or arresting agencies.)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
There is a $50 non-refundable ling fee per application, due at the time of ling. The clerk cannot take your
application without proper payment of this fee.
If an expungement order is granted, you will be charged an additional fee of $250 (“expungement fee”), which
you may pay in installments. If you would like to ask the Court to establish an installment payment plan, you will
need to ll out the request below. Please note that the expungement cannot be completed until payment in full
is received.
A copy of your current expungement eligibility certication must be attached to this Application.
REQUEST FOR INSTALLMENT PAYMENT PLAN
q The Defendant requests that the Court establish an installment plan for the payment of the expungement fee of $250.
Defendant requests to pay $ ____________ q weekly q every other week q twice per month q monthly
q other _________________________________________________________________________ , until paid in full.
AOC-496.3
Rev. 6-19
Page 3 of 3
I hereby state that the information provided above is true and accurate to the best of my knowledge.
Note: Defendant/Applicant must sign this Application in the presence of a notary or the circuit court clerk so that the
notary/clerk can witness his/her signature.
____________________________________________
Defendant/Applicant
Signature
______________________________, 2_______
Date
_____________________________________________
Notary/Clerk
My Commission Expires: _________________________
Subscribed and sworn to before me by _____________________________________________ this ________ day of
____________________________, 2________.
By: _______________________________________ D.C.
_____________________________________________
Clerk
This Application to Vacate and Expunge a Felony Conviction was sent on the ______ day of ______________________,
______, to the Commonwealth or County Attorney who prosecuted the case and the County Attorney of the County where
the Judgment was entered.
By: _______________________________________ D.C.
FOR CLERK USE ONLY
NOTICE TO COMMONWEALTH/COUNTY ATTORNEY
Pursuant to KRS 431.073(2), the oce of the Commonwealth Attorney or County Attorney who prosecuted the case shall
le a response to this Application within sixty (60) days after being served with this notice. An extension may be granted
for good cause, but a hearing on the Application shall occur no later than one hundred twenty (120) days following the
ling of the Application. The oce of the Commonwealth or County Attorney shall notify the victim of the crime if there was
an identied victim.
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APPLICATION TO VACATE AND EXPUNGE FELONY CONVICTION COMMONWEALTH (Administrative Office of the Courts)

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Completed 9 February 2022

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