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IN THE SIXTH JUDICIAL CIRCUIT COURT IN AND (Pinellas County Clerk of the Circuit Court and Comptroller)

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IN THE SIXTH JUDICIAL CIRCUIT COURT
IN AND FOR PINELLAS COUNTY, FLORIDA
STATE OF FLORIDA, Case No: ____________________________
____________________________________
____________________________________
vs ____________________________________
____________________________________
Defendant/Petitioner
____________________________________
A/K/A and/or N/K/A
SPN: ________________ DOB: ______________ Report#____________________
ORDER TO SEAL RECORDS PURSUANT TO SECTION 943.059, FLORIDA STATUTES AND
FLORIDA RULE OF CRIMINAL PROCEDURE 3.692
THIS CAUSE having come on to be heard before me this date upon a petition to seal records
concerning the petitioner’s arrest on ________________(date) by the ____________________(arresting
agency) for __________________________________________________________________ (charges)
and the court being fully advised in the premises, the Court hereby finds:
1. The Petitioner has never been previously adjudicated guilty or adjudicated delinquent of
a criminal offense or comparable ordinance violation.
2. The Petitioner was not adjudicated guilty or adjudicated delinquent of charges stemming
from the arrest or criminal activity to which the instant petition pertains.
3. The Petitioner has not secured a prior records expunction or sealing.
4. A Certificate of Eligibility issued by the Florida Department of Law Enforcement
accompanied the instant petition for sealing non-judicial criminal history records, whereupon
it is
ORDERED AND ADJUDGED that the petition to seal is hereby granted. All court records pertaining
to the above-styled case shall be sealed in accordance with the procedures set forth in Florida Rule of
Criminal Procedure 3.692; and it is further
ORDERED AND ADJUDGED that the Clerk of this court shall forward a certified copy of this order to
the__ State Attorney, __ Special Prosecutor, __ Statewide Prosecutor, ___________________(arresting
agency), and the Sheriff of Pinellas County, who will comply with the procedures set forth in section
943.059, Florida Statutes, and appropriate regulations of the Department of Law Enforcement, and who
will further forward a copy of this order to any agency that their records reflect has received the instant
criminal history record information; and it is further
ORDERED AND ADJUDGED that ______________________________________ (arresting agency)
shall seal all information concerning indicia of arrest or criminal history record information regarding
the arrest or alleged criminal activity to which this petition pertains in accordance with the procedures
set forth in section 943.059, Florida Statutes, and Florida Rule of Criminal Procedure 3.692. All costs of
certified copies involved herein are to be borne by the Petitioner.
DONE AND ORDERED in chambers at Clearwater, Pinellas Florida, this _____ day of ____________
_____________________________
Circuit Judge
Certified Copies Sent To:
Attorney
Defendant
Florida Department Law Enforcement (FDLE)
Pinellas County Sheriff Office
__ State Attorney’s Office
PT Arresting Agency ___________________________
Pretrial Intervention
Probation- DOC
Probation Salvation Army
Department of Motor Vehicles
Department of Juvenile Justice
Domestic Violence Program
Unemployment Compensation Program
Other _____________________________________
IN THE SIXTH JUDICIAL CIRCUIT COURT
IN AND FOR PINELLAS COUNTY, FLORIDA
STATE OF FLORIDA, Case No: ____________________________
____________________________________
____________________________________
vs ____________________________________
____________________________________
Defendant/Petitioner
____________________________________
A/K/A and/or N/K/A
SPN _____________
AFFIDAVIT IN SUPPORT OF PETITION TO EXPUNGE OR SEAL RECORD
State of Florida
County of Pinellas
I, _________________________________________ (name of defendant/petitioner), am the
defendant/petitioner in the above-styled cause and I do hereby swear or affirm that:
1. I fully understand the meaning of all the terms of this affidavit.
2. I have never been adjudicated guilty or adjudicated delinquent of a criminal offense or a comparable ordinance
violation.
3. I was arrested on ______________________ (date of arrest),
by ___________________________________________ (arresting agency) and I have not been adjudicated
guilty or adjudicated delinquent of the charges stemming from that arrest or the alleged criminal activity
surrounding my arrest.
4. I am eligible for the relief requested, to the best of my knowledge and belief, and do not have any other petition to
expunge or seal pending before any court.
5. I have never secured a prior records expunction or sealing under any law.
6. (For use in expunction petitions only) My record of arrest for this date has been sealed for at least ten years;
or an indictment, information or other charging document was not filed against me for the above criminal
transaction; or an indictment, information or other charging document, filed against me was dismissed by
prosecutor or the court.
___________________________________
Petitioner
Sworn to and subscribed before me on _________________
Personally known ________ or produced identification _________
Type of identification produced ____________________________
My commission expires:__________________________________
NOTARY PUBLIC, or other person authorized to
administer an oath.
______________________________________________
Printed, typed, or stamped commissioned name of Notary Public
IN THE SIXTH JUDICIAL CIRCUIT COURT
IN AND FOR PINELLAS COUNTY, FLORIDA
STATE OF FLORIDA, Case No: _______________________
_______________________
vs _______________________
_______________________
______________________________________________
Defendant/Petitioner
______________________________________________
A/K/A and/or N/K/A
SPN _____________
PETITION TO EXPUNGE OR SEAL RECORD
The Petitioner, ______________________________________________ petitions this
honorable Court, pursuant to Florida Rule of Criminal Procedure 3.692 and section
943.0585 (Expungement) or 943.059 (Sealing) Florida Statutes, to _______(expunge/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 ___________________ (date of arrest) by
_________________________________________________________________(arresting agency),
for _____________________________________________________________________________
______________________________________________ (charges) and as grounds therefore shows:
1. On __________________ (date of arrest), the petitioner __________________________
a ________________(race)________(sex) whose date of birth is ________________, was
arrested by _________________________________________________ (arresting agency),
and charged with ___________________________________________________________
_________________________________________________________________ (charges).
2. The petitioner has not been adjudicated guilty or adjudicated delinquent of any of the
charges stemming from this arrest or alleged criminal activity.
seal
3. The petitioner has not been previously adjudicated guilty or adjudicated delinquent of a
criminal offense or a comparable ordinance violation. The Petitioner has not secured a
prior records expunction or sealing under section 943.0585, 943.059, 943.058, 893.14, or
former section 901.33, Florida Statues, or any other law, rule or authority.
4. (To be used only when requesting expunction) Such record has been sealed under
section 943.059, 943.058, 893.14, or former section 901.33, Florida Statutes, for at least
ten years; or there has not been an indictment or information filed against the petitioner
who is the subject of this criminal history record information; or an indictment,
information or other charging document filed against the petitioner was dismissed by the
prosecutor or the court.
5. A Certificate of Eligibility for Expunction or Sealing of non-judicial criminal history
records issued by the Department of Law Enforcement accompanies this petition.
WHEREFORE, the Petitioner moves to ___________________ (expunge/seal) any criminal
history record information and any official Court records regarding his/her arrest by
_____________________________________________________________ (arresting agency) for
______________________________________________________________________ (charges)
on _____________________ (date of arrest).
I HEREBY CERTIFY that a true and correct copy of the foregoing pleading has been served on
____________________________________________ (name of prosecuting authority), State
Attorney for the __________ Judicial Circuit, in and for ________________________ County,
__________ Special Prosecutor, _________Statewide Prosecutor; ________________________
(arresting agency) and ____________________________ (Sheriff of county where defendant was
arrested, if different), on this ______________ day of ______________, ________ .
___________________________________________________
(Signature of Petitioner or Attorney for Defendant)
Name: _____________________________________
Address: ____________________________________
City/State/Zip Code: __________________________
Telephone: __________________________________
Florida Bar No: ______________________________
seal
6th
Pinellas County
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IN THE SIXTH JUDICIAL CIRCUIT COURT IN AND (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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