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AOC-496.2 Doc. Code: PEXC
Rev. 7-16
Page 1 of 2
Commonwealth of Kentucky
Court of Justice www.courts.ky.gov
KRS 431.078; 218A.275(8);
218A.276(8); 431.079
PETITION FOR EXPUNGEMENT
(FOR MISDEMEANOR, VIOLATION, OR
TRAFFIC INFRACTION CONVICTION)
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COMMONWEALTH OF KENTUCKY PLAINTIFF
VS.
________________________________________________ NAME DEFENDANT
________________________________________________ ADDRESS
________________________________________________
Jail ID Number________________(optional)
Defendant’s Birthdate:_______________Defendant’s SSN:__________________Violation/Arrest Date:_____________
Comes now the Defendant herein, and petitions the Court, pursuant to KRS 431.078, to expunge the following
misdemeanor, violation, or trafc infraction charge(s) in the above-referenced case:
CHARGE: ______________________________________
CHARGE: ______________________________________
CHARGE: ______________________________________
CHARGE: ______________________________________
CHARGE: ______________________________________
CHARGE: ______________________________________
In support of this Petition, the Defendant states as follows:
1. The Defendant was convicted of the misdemeanor(s), violation(s) or trafc infraction(s) charged above.
2. The above-stated offense(s) is/are not a sex offense(s) or an offense(s) committed against a child.
3. The Defendant has not, been convicted of a felony or misdemeanor in the ve years prior to the ling of this Petition.
4. The offense(s) is/are not subject to enhancement for a second or subsequent offense or the time for such enhancement
has expired.
5. No proceeding concerning a felony or misdemeanor is pending or being instituted against Defendant.
6. This petition q is led no sooner than ve (5) years after completion of Defendant’s sentence or ve (5) years after
successful completion of the Defendant’s probation, whichever is later; OR q involves Defendant's 1st conviction for
possession of controlled substances voided under KRS 218A.275(8); OR q involves a conviction for possession of
marijuana or synthetic drugs or salvia voided under KRS 218A.276(8).
7. List the names and addresses of all victims of the crimes listed above and any other person(s) whom Defendant/Petitioner
has reason to believe may have information relevant to the expungement:
Victims: __________________________________________________________________________________
_________________________________________________________________________________________
Persons with relevant information: ___________________________________________________________
_________________________________________________________________________________________
NOTE: A SEPARATE PETITION MUST BE FILED FOR EACH CRIMINAL CASE AND THE CHARGE(S) MUST BE
LISTED IN THIS PETITION FOR THE CHARGE(S) TO BE EXPUNGED. ADDITIONALLY, A COPY OF YOUR CURRENT
EXPUNGEMENT ELIGIBILITY CERTIFICATION MUST BE ATTACHED TO THIS PETITION.
Case No. ____________________
Court ____________________
County ____________________
Division ____________________
_________________________________PHONE NUMBER
District
Jefferson
KENTUCKY
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AOC-496.2
Rev. 7-16
Page 2 of 2
Date: ____________________________, _______. ___________________________________________
Defendant/Petitioner Signature
This Petition for Expungement was sent on the ______ day of _______________________, ______, to Defendant/
Petitioner or his/her attorney; the County Attorney; all crime victim(s) identied by Defendant/Petitioner or in the court
record sought to be expunged; and all other person(s) whom Defendant/Petitioner has reason to believe may have
information relevant to the expungement.
____________________________________________
Clerk
By: _____________________________________ D.C.
FOR CLERK USE ONLY
NOTIFICATION OF EXPUNGEMENT HEARING
This case is set for a hearing on _______________________, ______, at the hour of _______ q a.m. q p.m. at
the ________________________________ q District q Circuit Court.
Dated this _____ day of ___________________________, ______.
_________________________________________
Clerk
By: _____________________________________ D.C.
Subscribed and sworn to before me by ________________________________________________________________
this _______ day of ______________________, _______.
____________________________________________
Notary/Clerk
My commission expires: ___________________, _______ By: ____________________________________ D.C.
THERE IS A $100 FEE PER CASE, PAYABLE AT THE TIME OF FILING. THE CLERK CANNOT TAKE YOUR PETITION
WITHOUT PROPER PAYMENT OF THE FEE. IF AN EXPUNGEMENT ORDER IS NOT GRANTED, $50.00 OF THIS
FEE IS NOT REFUNDABLE.
County
Case No.
The Defendant prays that this Petition for Expungement of a Misdemeanor, Violation, or Traffic Infraction Conviction
be granted and that this Court enter an Order that the following agencies expunge any records in the agencies custody
regarding these charges: LIST AGENCIES AND ADDRESSES HERE:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Note: Defendant/Petitioner must sign this petition in the presence of a notary or the circuit court clerk so that the notary/
clerk can notarize his/her signature.
Jefferson
Click to Erase Name from Notary Box
AOC-496
Rev. 7-16
Page 1 of 2
Commonwealth of Kentucky
Court of Justice www.courts.ky.gov
KRS 431.078; 218A.275(8);
218A.276(8)
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PLAINTIFF
DEFENDANT
Jail ID Number________________(optional)
Defendant’s Birthdate:_______________Defendant’s SSN:__________________ Arrest Date:_____________
FINDINGS OF FACT
Case No. ____________________
Court ____________________
County ____________________
Division ____________________
COMMONWEALTH OF KENTUCKY
VS.
________________________________________________ NAME
________________________________________________ ADDRESS
________________________________________________
_________________________________PHONE NUMBER
EXPUNGEMENT ORDER
(FOR MISDEMEANOR, VIOLATION, OR
TRAFFIC INFRACTION CONVICTION)
The Court, having held a hearing on Defendant's Petition for Expungement and being sufficiently advised, FINDS:
1. Defendant has moved this Court to expunge the above-styled case wherein Defendant was convicted of the following
misdemeanor(s), violation(s), or traffic infraction(s):
CHARGE:_______________________________________ CHARGE:_______________________________________
CHARGE:_______________________________________ CHARGE:_______________________________________
CHARGE:_______________________________________ CHARGE:_______________________________________
2. The above-stated offense(s) is/are not a sex offense(s) or an offense(s) committed against a child;
3. Defendant has not been convicted of a felony or misdemeanor in the five (5) years prior to the filing of this Petition;
4. No proceeding concerning a felony or misdemeanor is pending or being instituted against Defendant;
5. The offense(s) is/are not subject to enhancement for a second or subsequent offense or the time for such enhancement
has expired; AND
6. The petition is filed no sooner than five (5) years after completion of Defendant's sentence or five (5) years after successful
completion of the defendant's probation, whichever is later;OR involves Defendant's 1st conviction for possession of
controlled substances voided under KRS 218A.275(8); OR involves a conviction for possession of marijuana or synthetic
drugs or salvia voided under KRS 218A.276(8).
7. Other:
District
Jefferson
KENTUCKY
AOC-496
Case No.
Rev 7-16.
Page 2 of 2
THEREFORE, IT IS HEREBY ORDERED:
AGENCY CERTIFICATION
___________________________________________________________, an above-named agency ordered to
expunge records in our custody, hereby certifies that the agency has no records in its custody relating to the
Defendant/matter OR the agency has completed the expungement as directed by this Court.
Date: ______________________ , 2_______. Agency Records Custodian: _______________________________
Date:_______________________, 2_____________. ________________________________________JUDGE
Distribution: Original - Court File
Copies: Defendant/Attorney; Kentucky State Police 1266 Louisville Road, Frankfort, KY 40601; Named Agencies
County
1. The petition is DENIED. (Doc Code: OEXD) The clerk shall refund $50.00 of the fee(s) paid for expungement.
2. The petition is GRANTED. (Doc Code: OEXG)
a. The above offense(s) is/are expunged from the court's records. Upon entry of this order, the proceedings in the
case(s) shall be deemed never to have occurred. Defendant and the Court may properly reply no record exists
with respect to Defendant upon any inquiry and Defendant shall not have to disclose the fact of the record or any
matter relating thereto on any application for employment, credit, or other purpose.
b. The Kentucky State Police and other following agencies are hereby ordered to expunge any records in their
custody regarding the above-named Defendant and offense(s):
Jefferson
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NOTE: A SEPARATE PETITION MUST BE FILED FOR

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Completed 28 January 2022

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