EXPUNGEMENT FILED IN A CIRCUIT COURT – ACQUITTAL/DISMISSAL is filed.
FORM CC-1473 MASTER 11/15
Case No. ............................................................................... PETITION FOR EXPUNGEMENT
FILED IN A CIRCUIT COURT –
ACQUITTAL/DISMISSAL
Commonwealth of Virginia VA. CODE § 19.2-392.2 A
............................................................................................................................................................................................. Circuit Court
CITY OR COUNTY
.............................................................................................................................................................................................................................................................
STREET ADDRESS OF COURT
................................................................................................................................
.......................................................... v. Commonwealth of Virginia
NAME OF PETITIONER
1. This petition to expunge the police and court records, including electronic records, relating to the charge(s) detailed in
Part 2 (below) is based on subsection A of § 19.2-392.2, as the petitioner was charged with the commission of a crime or
offense AND
(CHECK ONE)
[ ] has been acquitted of the charge.
[ ] a nolle prosequi of the charge has been taken or the charge has been otherwise dismissed, including dismissal by
accord and satisfaction pursuant to Virginia Code Section 19.2-151.
2. I further state that:
Petitioner’s date of birth is:
.............................................................
Petitioner’s full name at the time of arrest:
.............................................................................................................................................................
Specific charge(s) to be expunged:
.............................................................................................................................................................................
If matter was heard on appeal from General District Court, list applicable General District Court case number(s):
....................................................................................................................................................................................................................................................
[ ] A copy of the warrant or indictment is attached to this petition. Underlying Case No.(s) ..........................................................
Date of arrest:
................................................... Name of arresting agency: .........................................................................................
[ ] A copy of the warrant or indictment [ ] date of arrest or name of arresting agency is not reasonably available
because (state reason this information is not available):
....................................................................................................................................................................................................................................................
Date(s) of final disposition of charge(s): .......................... Court disposing of charge(s): ......................................................................
............................................................................................................ ....................................................................................................................................
The continued existence and possible dissemination of information relating to the arrest of the petitioner causes or may cause
circumstances which constitute a manifest injustice to the petitioner. For this reason, I request that the police and court
records, including electronic records, relating to the charge(s) be expunged and that a copy of any order of expungement be
forwarded to the Department of State Police pursuant to subsection K of § 19.2-392.2.
........................................................................
DATE
_______________________________________________________________________
SIGNATURE OF [ ] PETITIONER [ ] ATTORNEY FOR PETITIONER
................................................................................................................................................
PRINT NAME
.............................................................................................................................................................................................................................................................
ADDRESS/TELEPHONE NUMBER OF [ ] PETI
TIONER [ ] ATTORNEY FOR PETITIONER
[ ] I certify that I provided the petitioner a certified copy of this petition. Hearing date and time: ......................................................
........................................................................
DATE
_______________________________________________________________________
CLERK
Checklist for petitioner:
[ ] File completed P
ETITION FOR EXPUNGEMENT FILED IN A CIRCUIT COURT – ACQUITTAL/DISMISSAL in the circuit court of
the county or city in which the charge(s) was disposed of, together with all applicable fees and costs and, if required by
the clerk of the court, a completed C
OVER SHEET FOR FILING CIVIL ACTIONS, circuit court form CC-1416.
[ ] Obtain one complete set of fingerprints from a law-enforcement agency and provide a copy of this petition to such law-
enforcement agency.
[ ] Have a copy of this petition served on the Commonwealth’s Attorney in the county or city in which the P
ETITION FOR
