IN THE CIRCUIT/COUNTY COURT OF THE FOURTH JUDICIAL CIRCUIT
IN AND FOR CLAY COUNTY, FLORIDA
THE STATE OF FLORIDA ,
Plaintiff, CASE NO.:
vs. DIVISION:
,
Defendant.
/
PETITION TO SEAL
The Petitioner, by and through the undersigned attorney, petitions this honorable court, pursuant to Florida
Rule of Criminal Procedure 3.692 and Section 943.059, Florida Statutes, to seal all criminal history record
information in the custody of any criminal justice agency and the official records of the court concerning the
Petitioner’s arrest on the day of , 20 , by
(arresting agency), for ,
(charges), and as grounds therefor shows:
1. On the day of , 20 , the Petitioner, ,
a (race)/ (sex), whose date of birth is , was arrested by
and charged with
.
2. The Petitioner has not been previously adjudicated guilty of any of the charges stemming from this arrest or
alleged criminal activity.
3. The Petitioner has not been previously adjudicated guilty of a criminal offense or a comparable ordinance
violation.
4. The Petitioner has not secured a prior record expunction or sealing under section 943.0585, or 943.059,
Florida Statutes, former section 943.058, Florida Statutes, former section 893.14, Florida Statutes, or former
section 901.33, Florida Statutes, or any other law, rule or authority.
5. The Petitioner has applied for and been issued a Certificate of Eligibility, Number
,
by the Florida Department of Law Enforcement.
WHEREFORE, the Petitioner moves to seal any criminal history record information and any official court records
regarding his/her arrest by
(agency) for
(charges) on the day of , 20 .
I HEREBY CERTIFY that a true and correct copy of the foregoing pleading has been served on Melissa Nelson,
State Attorney of the Fourth Judicial Circuit, in and for Clay County, 825 North Orange Ave., Green Cove Springs,
FL 32043:
(arresting agency); and the Clay County Sheriff’s
Office, Records Section, 901 North Orange Avenue, Green Cove Springs, FL 32043, this day of
, 20 .
Signature Print Name
Address
