Fillable IN RE THE PETITION FOR EXPUNGEMENT OF RECORDS (Indiana Legal Help)

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IN RE THE PETITION FOR EXPUNGEMENT OF RECORDS (Indiana Legal Help)

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Page 1 of 2 Approved by the Coalition for Court Access
CCA-GF-0120-3016
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ _________________ COURT
COUNTY OF __________________ CAUSE NO. ____________________________________
IN RE THE PETITION FOR EXPUNGEMENT
OF RECORDS OF ARREST, CRIMINAL CHARGES,
OR JUVENILE DELINQUENCE ALLEGATIONS OF:
___________________________________
Petitioner
APPEARANCE BY UNREPRESENTED PERSON IN EXPUNGEMENT MATTER
1. My name is _________________________________ and I am the Petitioner in this case I am
not represented by a lawyer.
2. My current address is:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
OR, if in a related case, you have used the Attorney General confidential address, you may check
the box below:
☐ Attorney General confidential address
3. This is an XP case type as defined in Administrative Rule 8(B)(3).
4. There are related cases: (If yes, please indicate below)
☐ Yes
☐ No
Caption and case number of related cases:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
____________
Page 2 of 2 Approved by the Coalition for Court Access
CCA-GF-0120-3016
www.indianalegalhelp.org
Caption: Case No.:
Caption: Case No.:
Additional information as required by local rule:
Signature
CERTIFICATE OF SERVICE
☐I hereby certify that I sent a copy of this document on ________________________ by first-
class U.S. mail, postage prepaid or via hand-delivery to the _______________________ County
Prosecutor at the following address:
______________________________
______________________________
______________________________
☐I hereby certify that on _________________________ a copy of this document was served
upon the _________________________ County Prosecutor via the Indiana E-filing System.
______________________________
Signature
Page ______ of ______ Approved by the Coalition for Court Access
CCA-XP-0120-7000
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ _________________ COURT
COUNTY OF __________________ CAUSE NO. ____________________________________
☐ An Exhibit listing additional cause numbers is attached
IN RE THE PETITION FOR EXPUNGEMENT/SEALING
OF RECORDS OF ARREST, CRIMINAL CHARGES, Related Criminal Cause Numbers
OR JUVENILE DELINQUENCE ALLEGATIONS OF: ___________________________________
___________________________________
___________________________________ ___________________________________
Petitioner ___________________________________
VERIFIED PETITION FOR EXPUNGEMENT OF AND SEALING OF RECORDS OF ARREST,
CRIMINAL CHARGES, OR JUVENILE DELINQUENCY ALLEGATIONS PURSUANT TO I.C. §
35-38-9-1
Comes now the Petitioner _______________________________________, in person and duly sworn
upon Petitioner’s oath, and files their Petition For Expungement And Sealing Of Records Arrest, Criminal
Charges Or Juvenile Delinquency Allegations under the provisions of IC § 35-38-9-1 and would respectfully
request that the Court grant said petition and find that the records related to the cause numbers addressed in
this petition be expunged pursuant to statute and that records be removed from public access in accordance
with IC § 35-38-9-1(f). In support thereof, the Petitioner would swear and affirm to the following factual
information:
INFORMATION PERTAINING TO ALL EXPUNGEMENT MATTERS:
1. Petitioner’s full name is __________________________________________, and Petitioner has used
the following other names or aliases:
_________________________________________________________________________________________
_________________________________________________________________________________________
2. Petitioner’s date of birth is ______________________________; Petitioner’s Social Security Number
is XXX-XX-____________; and Petitioner’s driver license or state identification number is _______________
3. No charges are currently pending against the Petitioner, and Petitioner is not currently participating in a
pretrial diversion program.
____________
Take out this page and insert your
non-conviction Facts pages (from
the Non Conviction Insert Forms)
Page ______ of ______ Approved by the Coalition for Court Access
CCA-XP-0120-7000
www.indianalegalhelp.org
WHEREFORE, Petitioner respectfully requests that this Court grant this Petition and issue the
following orders, pursuant to I.C. §35-38-9-1(f), regarding each Expungement Matter addressed by this
petitioner:
1. Order all information placed or retained in any state central repository for criminal history
information or in any other alphabetically arranged criminal history information system
maintained by a local, regional, or statewide law enforcement agency removed by the following
agencies:
a. Indiana State Police;
b. ________________________County Sheriff’s Department;
c. _______________________________________________;
d. _______________________________________________;
e. _______________________________________________.
☐ Order the records of the sentencing court, a juvenile court, the Court of Appeals, and the
Supreme Court concerning the person shall be redacted or permanently sealed;
☐ As to the following appellate cause numbers:
_____________________________________________________________________________
_____________________________________________________________________________
order the Clerk of the Appellate Courts to:
a. seal or redact any records in the clerk’s possession that relate to the arrest, criminal
charges, juvenile delinquency allegation, vacated conviction, or vacated juvenile
delinquency adjudication;
b. redact the opinion or memorandum decision as it appears on the computer gateway
administered by the office of technology so that it does not include the petitioner’s name
(in the same manner that opinions involving juveniles are redacted) and provide a
redacted copy of the opinion to any publisher or organization to whom the opinion or
memorandum decision is provided after the date of the order of expungement; and
Grant all other relief just and proper in the premises.
AFFIRMATION
I affirm under penalties for perjury that the foregoing representations and statements are
true and accurate.
Respectfully submitted,
_________________________________________
Signature
_________________________________________
Printed Name
Page ______ of ______ Approved by the Coalition for Court Access
CCA-XP-0120-7000
www.indianalegalhelp.org
CERTIFICATE OF SERVICE
☐I hereby certify that I sent a copy of this document on ________________________ by first-
class U.S. mail, postage prepaid or via hand-delivery to the _______________________ County
Prosecutor at the following address:
______________________________
______________________________
______________________________
☐I hereby certify that on _________________________ a copy of this document was served
upon the _________________________ County Prosecutor via the Indiana E-filing System.
______________________________
Signature
Page 1 of 1 Approved by the Coalition for Court Access
CCA-XP-0120-7002
www.indianalegalhelp.org
Form ACR (Access to Court Records)
STATE OF INDIANA IN THE __________________ _________________ COURT
COUNTY OF __________________ CAUSE NO. ____________________________________
IN RE THE PETITION FOR EXPUNGEMENT
OF RECORDS OF ARREST, CRIMINAL CHARGES,
OR JUVENILE DELINQUENCE ALLEGATIONS OF:
___________________________________
Petitioner
Notice of Exclusion of Confidential Information from Public Access
(FILED WITH TRIAL COURT CLERK)
Contemporaneous with the filing of this notice, _______________________________ has filed
confidential information under the Indiana Rules on Access to Court Records. ___________________________,
provides this notice that the confidential information is to remain excluded from public access in accordance
with the authority listed below:
Name or description of document
ACR grounds for exclusion
Confidential Information Form listing
Petitioner’s full Social Security Number
Access to Court Records Rule 5
________________________________
Signature
CERTIFICATE OF SERVICE
☐I hereby certify that I sent a copy of this document on ________________________ by first-
class U.S. mail, postage prepaid or via hand-delivery to the _______________________ County
Prosecutor at the following address:
______________________________
______________________________
______________________________
☐I hereby certify that on _________________________ a copy of this document was served
upon the _________________________ County Prosecutor via the Indiana E-filing System.
______________________________
Signature
____________
Not Public Record
CONFIDENTIAL INFORMATION FORM
XP CAUSE NUMBER: __________________________________________________________
PETITIONER’S NAME: _________________________________________________________
PETITIONER’S FULL SOCIAL SECURITY NUMBER: _______________________________
ATTENTION CLERK: FOR SELF REPRESENTED LITIGANTS TREAT THIS FORM
AS IF IT IS PRINTED ON GREEN PAPER.
IF THIS DOCUMENT IS E-FILED, FILE THIS AS A CONFIDENTIAL DOCUMENT
Not Public Record
NOT FOR PUBLIC RECORD
NOT PUBLIC RECORD Approved by the Coalition for Court Access
CCA-XP-0120-7006
www.indianalegalhelp.org
STATE OF INDIANA IN THE __________________ _________________ COURT
COUNTY OF __________________ CAUSE NO. ____________________________________
☐ An Exhibit listing additional cause numbers is attached
IN RE THE PETITION FOR EXPUNGEMENT/SEALING
OF RECORDS OF ARREST, CRIMINAL CHARGES, Related Criminal Cause Numbers
OR JUVENILE DELINQUENCE ALLEGATIONS OF: ___________________________________
___________________________________
___________________________________ ___________________________________
Petitioner ___________________________________
FINDINGS AND ORDER GRANTING PETITION FOR EXPUNGEMENT/SEALING OF
RECORDS OF ARREST, CRIMINAL CHARGES, OR JUVENILE DEINQUENCY
ALLEGATIONS PURSUANT TO I.C. § 335-38-9-1
Petitioner, _______________________________, [by counsel, _______________________________,]
filed a Verified Petition for Expungement/Sealing Of Records Of Arrest, Criminal Charges, Or Juvenile
Delinquency Allegations, and the State of Indiana, by counsel
, ☐ filed ☐ did not file its response to said
Petition.
Petitioner’s Verified Petition for Expungement seeks relief as provided by I.C. § 35-38-9-1 for an arrest,
criminal charge, or juvenile delinquency allegation that did not result in a conviction.
☐ Upon review of said Petition ☐ and the State of Indiana’s Response, the Court finds that the State
has stated no legal basis upon which to state an objection to the Court’s granting of Petitioner’s
Verified Petition for Expungement/Sealing of Arrest Records.
☐ A hearing was held on _____________________________ regarding said Petition of which all
parties were given notice and during which all parties were given an opportunity to present evidence
and arguments.
The Court now enters the following Findings and Order on Petitioner’s Verified Petition for Expungement:
FINDINGS AS TO ALL EXPUNGEMENT MATTERS:
1. Petitioner’s full name is __________________________________, and Petitioner has used the
following other names or aliases:
___________________________________________________________________________________
___________________________________________________________________________________
2. Petitioner’s date of birth is _____________________________; Petitioner’s Social Security Number is
________________________; and Petitioner’s driver’s license number is _______________________.
3. No charges are currently pending against the Petitioner, and Petitioner is not currently participating in a
pretrial diversion program.
____________
Take out this page and insert your
non-conviction Findings pages
(from the Non Conviction Insert
Forms)
Take out this page and insert your
non-conviction Exhibit pages (from
the Non Conviction Insert Forms)
NOT FOR PUBLIC RECORD
NOT PUBLIC RECORD Approved by the Coalition for Court Access
CCA-XP-0120-7006
www.indianalegalhelp.org
ORDER
It is therefore ORDERED, ADJUDGED, and DECREED that Petitioner’s VERIFIED PETITION FOR
EXPUNGEMENT/SEALING OF RECORDS OF ARREST, CRIMINAL CHARGES, OR JUVENILE
DELINQUENCY ALLEGATIONS shall be GRANTED as to Expungement Matters ________________
(pertaining to ALL records related to the following criminal and MC cause numbers:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
and DENIED as to Expungement Matters _______________________________(pertaining to records related to
cause numbers:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
1. As to all Expungement Matters on which expungement is granted:
a. As required under I.C. § 35-38-9-1(g), all information necessary to identify particular agency
records that are to be expunged pursuant to this Order has been included in Exhibit A attached to and
incorporated in this Order.
b. All information placed or retained in any state central repository for criminal history i
nformation or in any other alphabetically arranged criminal history information system maintained by a local,
regional, or statewide law enforcement agency shall be removed by the following agencies:
i. Indiana State Police;
ii. ____________________ County Sheriff’s Department;
iii. ____________________________________________;
iv. ____________________________________________;
v. ____________________________________________.
The records of the sentencing court, a juvenile court, the Indiana Court of Appeals, and the Indiana Supreme
Court concerning the person shall be redacted or permanently sealed;
As to court records stored under the following appellate cause/case numbers:
__________________________________________________________________________________________
__________________________________________________________________________________________
i. The Clerk of the Supreme Court shall seal or redact any records in the Clerk’s possession that
relate to the arrest, criminal charges, juvenile delinquency allegation, vacated conviction, or
vacated juvenile delinquency adjudication;
ii. The Clerk of the Supreme Court shall redact the opinion or memorandum decision as it appears
on the computer gateway administered by the office of technology so that it does not include the
petitioner’s name (in the same manner by which opinions involving juveniles are redacted) and
provide a redacted copy of the opinion to any publisher or organization to whom the opinion or
memorandum decision is provided after the date of the order of expungement.
NOT FOR PUBLIC RECORD
NOT PUBLIC RECORD Approved by the Coalition for Court Access
CCA-XP-0120-7006
www.indianalegalhelp.org
2. Nothing in this Order shall be construed to prevent the Indiana bureau of Motor Vehicles from reorting
information about a conviction for a violation of a traffic control law to the Commercial Drivers
License Information System (CDLIS) in accordance with I.C. § 9-24-6-2(d).
SO ORDERED this _______________________________________________.
_________________________________________
Judicial Officer
Notice to be given by: ☐ Court ☐ Clerk ☐ Other:
PROOF OF NOTICE
A copy of the entry was served either by mail to the address or record, deposited in the attorney’s
distribution box, or personally distributed to the following persons:
State of Indiana: __________________________________________________________
Petitioner: _______________________________________________________________
Date of notice:
Initial of person who notified parties: ☐ Court ☐ Clerk ☐ Other
Distribution to:
☐ ___________________________________ Indiana State Police
Attorney for Petitioner Attn: Records Division
______________________________________ 100 N Senate Ave., Room N301 (East)
______________________________________ Indianapolis, IN 46204
☐ ___________________________________ Bureau of Motor Vehicles
Petitioner IGC North, Room 402
______________________________________ 100 North Senate Avenue
______________________________________ Indianapolis, IN 46204
_____________________ County Prosecutor Indiana Department of Correction
Attn: __________________________________ Attn: Records Division
_______________________________________ 302 W. Washington Street, Room E-334
_______________________________________ Indianapolis, IN 46204
___________________ County Sheriff’s Dept. Office of the Indiana Attorney General
_______________________________________ Indiana Government Center South, 5
th
Floor
_______________________________________ 302 W. Washington Street
Indianapolis, IN 46204
NOT FOR PUBLIC RECORD
NOT PUBLIC RECORD Approved by the Coalition for Court Access
CCA-XP-0120-7006
www.indianalegalhelp.org
☐ ______________________ County Clerk
_______________________________________ ☐ Clerk of the Appellate Courts
_______________________________________ 216 State House
[check this box only if this ORDER applies to court 200 West Washington Street
records pertaining to a PROBATION that was Indianapolis, IN 46204
transferred to another county.] [check this address only if one or more of the
expunged cases was appealed.]
Law Enforcement Agencies:
________________________________________ ☐ Indiana Supreme Court
________________________________________ Office of Judicial Administration
________________________________________ Trial Court Technology
________________________________________ 251 N. Illinois Street, Ste. 700
________________________________________ Indianapolis, Indiana 46204
________________________________________ [check this address only if a NO CONTACT
________________________________________ ORDER was issued in one or more of the
________________________________________ expunged cases as a condition of PRE-TRIAL
________________________________________ RELEASE or PROBATION.]
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
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IN RE THE PETITION FOR EXPUNGEMENT OF RECORDS (Indiana Legal Help)

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Completed 31 December 2021

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