400-00171 – Petition to Expunge Juvenile Diversion Record (07/2019) Page 1 of 1
PETITION TO EXPUNGE JUVENILE DIVERSION RECORD
I, __________________________, request that the Court order my juvenile Diversion record be expunged.
Pursuant to 3 V.S.A. 163, I completed diversion prior to July 1, 2002 and as grounds for the request, I hereby
state as follows:
• two years has elapsed since the successful completion of Diversion and the dismissal of the case;
• there has not been a charge or conviction of a subsequent felony or misdemeanor during the two-year
period, and no proceedings are pending seeking such charge or conviction;
• rehabilitation has been attained to the satisfaction of the court; and
• there is no restitution owed related to the case under a contract executed with the Restitution Unit.
Date of Signature
_____________________________ _______________________________________
Signature of Juvenile/Youth
_____________________________________
Printed Name of Juvenile/Youth
_________________________________________
Address
_________________________________________
City, State, Zip
_________________________________________
Phone
_____________________________________
Email Address
cc: State’s Attorney
Juvenile Attorney (if applicable)
