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 EXPUNGE
The Petitioner, by and through the undersigned attorney, petitions this honorable court, pursuant Florida
Rule of Criminal Procedure 3.692 and section 943.0585, Florida Statutes, to expunge 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 therefore 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 records 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 910.33, Florida Statutes, or any other law, rule or authority.
5. Such record has been sealed under section 943.059, Florida Statutes, former section 943.058, Florida
Statutes, former section 893.14, Florida Statutes, or former section 901.33, Florida Statutes, for at least
10 years; or there has not been an indictment or information filed against the petitioner who is the
subject of this criminal history information; or an indictment or information filed against the Petitioner
who is the subject of this criminal history information was dismissed by the Prosecutor or the Court.
6. 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 expunge 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 for the Fourth Judicial Circuit, in and for Clay County, Florida, 825 North Orange Avenue, Green
Cove Springs, Florida 32043;
(arresting agency); and the Clay
County Sheriff’s Department, Records Section, 901 North Orange Avenue, Green Cove Springs, Florida 32043,
this day of
, 20 .
Signature Printed Name
Address
