IN THE MUNICIPAL COURT OF THE CITY OF SALINA, KANSAS
CITY OF SALINA, Plaintiff,
vs. Case No. __________________
COMES NOW _______________________________, Defendant/Petitioner, and requests the Court order
expungement of the
PETITION FOR EXPUNGEMENT
____ conviction and related arrest records (OR)
____ diversion and related arrest records.
In support of this request, I state:
1. My full legal name is _________________________________________________.
2. My full name at the time of my arrest was (if different than stated above)
3. I am a ______________________ (race/sex), born on __________________________________.
4. My Social Security number is XXX-XX-_____________.
5. I was arrested by the Salina Police Department on ______________________ (date) on a charge of
6. I was convicted of the charge of _______________________________________________________
on ___________________________________ (date) in Salina Municipal Court. (OR)
I was granted a diversion on the charge of ________________________________________________
on ___________________________________ (date) in Salina Municipal Court.
7. More than _______ years have passed since I completed my sentence, OR was discharged from
probation, parole or a suspended sentence, OR since I fulfilled the terms of the diversion agreement.
8. I have not been convicted of a felony in the past two years and no proceeding involving any such crime is
presently pending or being instituted against me.
9. My circumstances and behavior warrant the expungement.