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CCA-XP-0220-7008
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FACTS PERTAINING TO EXPUNGEMENT MATTER ________:
CONVICTION FOR A MISDEMEANOR
CONVICTION FOR A __________ FELONY THAT WAS REDUCED TO A
MISDEMEANOR
1. Petitioner was arrested in _______________________ County on __________________ by
_________________________ employed by the law enforcement agency known as _____________________________
under law enforcement agency case number _________________________;
2. Peti
tioner was convicted on the following charges on _____________________________, under Cause Number
________________________________ in __________________ _________________ Court, Criminal Division,
Room__________.
Title
Class/Level
Count
Category
a.
b.
c.
d.
Said felony judgement was converted to a class A misdemeanor on __________________________.
3. Peti
tioner is not a person who is prohibited from seeking this remedy under the provisions of I.C. §35-38-9-2(b).
4. Elap
sed time:
Five (5) years have passed between the date of Petitioner’s conviction and the filing of this Petition.
Fewer than five (5) years have passed between the date of Petitioner’s conviction and the filing of this Petition,
but the ____________________ County Prosecuting Attorney has provided written consent for a shorter elapsed
time period (see Exhibit _____ attached, letter of consent from __________________________ County
Prosecutor).
5. Crimin
al activity within the previous five (5) years:
Petitioner affirms that to the best of their knowledge, they have not committed another crime in any jurisdiction
within the previous five (5) years.
Petitioner affirms that, to the best of their knowledge, they have not committed another crime in any jurisdiction
within the shorter elapsed time period to which the prosecuting attorney has agreed.
6. Petit
ioner has:
Paid all fines, fees, and court costs, and no restitution obligation was imposed as part of their sentence
Satisfied their restitution obligation of $_____________________ imposed as part of their sentence.
Been found indigent as to all outstanding fines, costs, and fees ordered as part of the sentence.
7. Appellate activity:
The case that Petitioner is requesting be sealed has not been appealed.
The case that Petitioner is requesting be sealed was appealed on ______________________ under the
following appellate cause number _____________________________.
8. Relat
ed MC cause numbers:
Court records stored under the following MC case/cause numbers constitute records of the sentencing court or
juvenile court for the purposes of this order:
__________________________________________________________________________________________
__________________________________________________________________________________________
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________________
______________
________________
______________
________________
______________
________________
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Page _____ of _____ Approved by the Coalition for Court Access
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NOT PUBLIC RECORD
FINDINGS PERTAINING TO EXPUNGEMENT MATTER ________:
CONVICTION FOR A MISDEMEANOR
CONVICTION FOR A __________ FELONY THAT WAS REDUCED TO A
MISDEMEANOR
The Court now finds by a preponderance of the evidence that:
1. Petitioner’s verified petition for expungement seeks relief as provided by I.C. §35-38-9-2 for a conviction
entered on the following changes on ____________________________, under Cause Number
______________________________________ in __________________ _________________, Criminal Division,
Room ___________.
Title
Class
Count
Category
a.
b.
c.
d.
Said felony judgement was converted to a class A misdemeanor on __________________________.
2. Petitioner is not a person who is prohibited from seeking this remedy under the provisions of I.C. §35-38-9-2(b).
3. Elaps
ed time:
Five (5) years have passed between the date of Petitioner’s conviction and the filing of this Petition.
Fewer than five (5) years have passed between the date of Petitioner’s conviction and the filing of this Petition,
but the ____________________ County Prosecuting Attorney has provided written consent for a shorter elapsed
time period (see Exhibit _____ attached, letter of consent from __________________________ County
Prosecutor).
4. Crimina
l activity within the previous five (5) years:
Petitioner affirms that to the best of their knowledge, they have not committed another crime in any jurisdiction
within the previous five (5) years.
Petitioner affirms that, to the best of their knowledge, they have not committed another crim in any jurisdiction
within the shorter elapsed time period to which the prosecuting attorney has agreed.
5. Peti
tioner has:
Paid all fines, fees, and court costs, and no restitution obligation was imposed as part of their sentence
Satisfied their restitution obligation of $_____________________ imposed as part of their sentence.
Been found indigent as to all outstanding fines, costs, and fees ordered as part of the sentence.
6. Appel
late activity:
The case that Petitioner is requesting be sealed has not been appealed.
The case that Petition is requesting be sealed was appealed on ______________________ under the following
appellate cause number _____________________________.
7. Related
MC cause numbers:
Court records stored under the following MC case/cause numbers constitute records of the sentencing court or
juvenile court for the purposes of this order:
__________________________________________________________________________________________
__________________________________________________________________________________________
The court now finds that the Petition as to EXPUNGEMENT MATTER ______ shall be GRANTED.
NOT
PUBLIC RECORD
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________________
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________________
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________________
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NOT PUBLIC RECORD
EXHIBIT _______, Page _____ of _________:
FI
NDINGS AND ORDER GRANTING PETITION FOR EXPUNGEMENT OF CONVICTION RECORDS
PURSUANT TO I.C. §35-38-9 (XP Cause Number: ________________________________________)
EXPUNGEMENT MATTER _______,
PETITIONER IDENTIFICATION INFORMATION:
Ful
l Name: ____________________________________ Alias Names, DOBs and SSNs:
DOB: ________________________________________ ______________________________________
SSN: ________________________________________ ______________________________________
______________________________________
Addresses since first criminal offense addressed in this Order:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
INDIVIDUAL ARREST INFORMATION:
Criminal Cause Number: _______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Arr
esting Agency: ____________________________________________
County/City of Arrest: _________________________________________
Law Enforcement Agency Case Number: __________________________
Dat
e of Arrest: ____________________ Date of Conviction: ______________________
List
of Charges: Disposition of Charges:
Expunged pursuant to I.C. § 35-38-9-6
Expunged pursuant to I.C. § 35-38-9-7
NOT expunged
NOT PUBLIC RECORD
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______________________
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________________
______________________
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________________
____________________
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