The court finds that the petitioner is eligible for the following requested
relief and makes the following order:
Order to Seal Arrest and Related
Records (Pen. Code, §§ 851.91, 851.92)
Judicial Council of California, www.courts.ca.gov
New January 1, 2019, Optional Form
Clerk stamps date here when form is filed.
Superior Court of California, County of
Clerk fills in the number and name of the case.
Trial Court Case Number:
Clerk fills in the name and street address of the
court.
v.
Trial Court Case Name:
People of the State of California
CR-410
Order to Seal Arrest and Related
Records (Pen. Code, §§ 851.91, 851.92)
The court GRANTS the petition. The record of arrest in the
following matter shall be sealed under the provisions of section
851.91, and the arrest deemed not to have occurred:
1
Petitioner may answer any question relating to the sealed arrest as
though it did not happen, and petitioner is released from all penalties and
disabilities resulting from the arrest, except as follows:
Law enforcement agency report number:
Prosecuting agency report number:
Court case number:
Other:
• The sealed arrest may be pleaded and proved in any later prosecution
of the petitioner for any other offense, and will have the same effect
as if it had not been sealed.
CR-410, Page 1 of 1
• The sealing of an arrest under this section does not affect petitioner’s authorization to own, possess, or have in his
or her custody or control any firearm, or his or her susceptibility to conviction under Chapter 2 (commencing
with section 29800) of Division 9 of Title 4 of Part 6, if the arrest would otherwise affect this authorization or
susceptibility.
• The sealing of an arrest under this section does not affect any prohibition from holding public office that would
otherwise apply under law as a result of the arrest.
Petitioner’s arrest does not qualify under Penal Code section 851.91(a).
The petition does not meet the requirements listed in Penal Code section 851.91(b)(1).
The court DENIES the petition (check one):
Other:
The court finds that sealing the arrest would not serve the interests of justice under Penal Code section
851.91(c)(2).
3
Signature of judicial officer
Date:
a.
b.
c.
d.
This is a Court Order.
• The sealing of an arrest under section 851.91 does not relieve the petitioner of the obligation to disclose the arrest,
if otherwise required by law, in response to any direct question contained in a questionnaire or application for
public office, for employment as a peace officer, for licensure by any state or local agency, or for contracting with
the California State Lottery Commission.
2
Last First Middle
Mailing address:
Street
City
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Name:
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