Fillable REQUEST TO EXPUNGE & IMPOUND AND/OR SEAL CRIMINAL (Microsoft)

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REQUEST TO EXPUNGE & IMPOUND AND/OR SEAL CRIMINAL (Microsoft)

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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
STATE OF ILLINOIS,
CIRCUIT COURT
COUNTY
REQUEST TO EXPUNGE &
IMPOUND AND/OR SEAL
CRIMINAL RECORDS
For Court Use Only
Instructions
Request of:
Your name
(First, middle, last name)
Directly above, enter
the name of county
where you will file the
case.
Enter your name, birth
date, race, and gender.
List any other names
you used when
arrested on the cases
Other names used in these cases
listed on this form.
Date of birth
Race
Gender
Case Number (if the Clerk
assigns a new number)
If the Clerk gave you a
new case number,
enter it to the right.
Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County:
Enter the number for
all eligible arrests and
charges on your
criminal record in this
county. If an arrest did
not result in formal
charges, enter the
arrest number.
IF YOU ARE ONLY
REQUESTING TO
SEAL CASES, DO
NOT FILL OUT
SECTIONS 2 - 11.
GO TO SECTION
12.
See How to Expunge
and/or Seal a Criminal
Record to make sure all
of your cases can be
erased by expunging
your record. For help
filling out this table,
see pages 12 – 15. Do
not list any
convictions in this
section.
In 2, enter all eligible
arrests or charges on
your record. Enter all
charges for each case
number.
For Outcome, enter an
outcome that matches
the outcome of your
case. Use the
shortened version of
the outcome from the
Outcome
Abbreviations box.
If you need more room,
use the Additional
Arrests or Cases for
Expungement form and
check the box.
1.
I am requesting to expunge and impound records.
Yes
No (If no, go to Section 12)
2.
I ask the Court to EXPUNGE AND IMPOUND the following arrests or charges from the
records of the Arresting Agency, the Circuit Clerk, and the Illinois State Police. I was arrested,
or charged without being arrested, and not convicted on the dates and for the offenses listed below:
Arrest or
Case Number
Arresting
Agency
Charge
(list all charges for each case number)
Date of
Arrest
Outcome (for
example, RV,
S or P)
Outcome Abbreviations
RV
Conviction Reversed or Vacated
P
Pardon from the Governor
CE
Certificate of Eligibility for Expungement from PRB
FI
Found Factually Innocent
RWC
Released Without Charge
DA
Dismissal or Acquittal
S
Supervision Successfully Completed
QP
Qualified Probation Successfully Completed
I have listed additional arrests or cases on the attached Additional Arrests or Cases for
Expungement form.
EX-R 2903.6
Page 1 of 4
(06/21)
In 3-11, check ALL
boxes that apply.
In 3, you cannot
expunge a criminal
conviction unless one
of the special situations
listed under
checkboxes a, b, c, or d
describes your case.
In 7, your record must
specifically state that
you had Qualified
Probation. It might also
be called Second
Chance, 410, 710,
1410, or TASC
probation.
In 8, if you got
supervision for any case,
5 years must have
passed since the end of
the sentence for:
• Domestic Battery;
• Criminal Sexual
Abuse;
• Driving without
Insurance;
• Driving with
registration suspended
for Non-Insurance;
• Display of False
Insurance Card;
• Scrap Processors to
Keep Records; OR
• 2 years must pass
since the end of the
sentence for all other
supervisions (except
those listed in 9,
which can never be
expunged).
IF YOU ARE ONLY
REQUESTING TO
EXPUNGE CASES,
DO NOT FILL OUT
SECTIONS 13 - 22.
See How to Expunge
and/or Seal a Criminal
Record to make sure
your cases can be
hidden by sealing your
record. For help filling
out this table see pages
12 – 15.
Enter the Case Number given by the Circuit Clerk: _________________________________
3.
I was not convicted of any offenses I want to expunge, unless (Check the box that applies):
a.
I was convicted, but the conviction was reversed or vacated; OR
b.
I received a pardon from the Governor of the State of Illinois allowing
expungement. (Attach a copy of the pardon.); OR
c.
I received a Certificate of Eligibility for Expungement by the Prisoner Review
Board. (Attach a copy of the Certificate.); OR
d.
I was found factually innocent in the case I am asking to expunge.
4.
For at least one case, I was arrested and released, and no charges were filed against me.
5.
For at least one case, I was arrested for a minor traffic offense and released from
custody without being charged.
6.
For at least one case, I was charged, but was later acquitted, or released without
being convicted.
7.
For at least one case, I received a sentence of Qualified Probation; AND
a.
At least 5 years have passed since my Qualified Probation ended successfully;
AND
b.
I have attached the results of a drug test that I passed within the last 30 days.
8.
For at least one case, I received a sentence of supervision; AND
a.
For certain offenses listed in the law, at least 5 years have passed since
I completed my supervision successfully; OR
b.
At least 2 years have passed since I completed my supervision successfully.
9.
I am NOT seeking to expunge any arrests or charges that resulted in supervision for:
a.
Driving Under the Influence; OR
b.
Any sexual offense against a person under the age of 18; OR
c.
Reckless Driving when I was 25 years of age or older.
10.
For at least one case, I received a sentence of supervision for Reckless Driving; AND
a.
I was under the age of 25 when the offense was committed; AND
b.
I have no other convictions for DUI or Reckless Driving; AND
c.
I have reached the age of 25.
11.
I qualify to have my filing fees and State Police fees waived under the Cook County
Fee Waiver Pilot Program:
a.
I am filing this Request in Cook County prior to January 1, 2022; AND
b.
I am only seeking to expunge or seal arrests that resulted in my release without
being charged or in cases that resulted in my acquittal, dismissal of the case, or a
reversed or vacated conviction.
12.
I am requesting to seal records.
Yes
No (If no, skip Sections 13- 22)
EX-R 2903.6
Page 2 of 4
(07/21)
I I I
I I I
Enter the Case Number given by the Circuit Clerk: _________________________________
13.
I ask the Court to SEAL the following arrests, charges, or convictions from the records of the
Arresting Agency, the Circuit Clerk, and the Illinois State Police:
In 13, enter all eligible
arrests, charges, and
convictions you want
sealed. Enter all
charges for each case
number. For Outcome,
enter an outcome that
reflects the outcome of
your case. Use the
shortened version of
the outcome from the
Outcome
Abbreviations box.
If you need more room
to list additional
eligible arrests or
charges use the
Additional Arrests or
Cases for Sealing form
and check the box.
14– 16 must be true for
you to use this form.
For 14, traffic offenses
cannot be sealed unless
they were an eligible
Class A or B
misdemeanor.
In 17 - 21, check ALL
boxes that apply.
In 17 and 18a –c, some
misdemeanor
supervisions and
convictions cannot be
sealed, like DUI, some
Reckless Driving
Offenses, Domestic
Battery, some Sexual
Offenses, and Dog
Fighting.
In 18b, some Class 3
and Class 4 felony
offenses can be sealed,
like Theft, Possession
of Cannabis,
Possession of a
Controlled Substance,
and a few others.
For a complete list of
crimes that can and
cannot be sealed, see
the How to Expunge
and/or Seal a Criminal
Record.
In 21, check the box if
you have completed one
of the listed educational
goals during your last
sentence. If 21 applies to
you, all eligible cases
can be sealed
immediately after the
completion of your last
sentence.
Arrest or Case
Number
Arresting
Agency
Charge
(list all charges for each case
number)
Date of
Arrest
Outcome (for
example, MC,
FC, or CE)
Outcome Abbreviations
MC
Misdemeanor Conviction
FC
Felony Conviction
CE
Certificate of Eligibility for Sealing from PRB
QP
Qualified Probation Successfully Completed
I have listed additional arrests or cases on the attached Additional Arrests or Cases for
Sealing form.
14.
I am not asking to seal arrests or charges for minor traffic offenses, unless I was released
without being charged.
15.
I am not asking to seal arrests or charges for felony offenses, unless the felony was reduced
to an eligible misdemeanor, or is otherwise eligible to be sealed.
16.
I am not asking to seal a felony conviction that happened after the sealing of a prior felony
conviction.
17.
At least 2 years have passed since I successfully completed my supervision, for eligible
offenses.
18.
At least 3 years have passed since the end of my last sentence (Unless #21 or 22 applies);
AND (Check all that apply):
a.
I received a misdemeanor conviction for an offense subject to sealing;
b.
I received a felony conviction for an offense subject to sealing. If it was a drug case,
I have attached the results of a drug test that I passed within the last 30 days.
c.
I successfully completed a sentence under Section 10 of the Cannabis Control Act,
Section 410 of the Illinois Controlled Substances Act, Section 70 of the
Methamphetamine Control and Community Protection Act, or Section 5-6-3.3
(Second Chance Probation) of the Unified Code of Corrections; AND I have
attached the results of a drug test that I passed within the last 30 days.
19.
I am not asking to seal a felony conviction for which I currently have to register on a
public registry, including the Arsonist Registration Act, the Sex Offender Registration Act,
or the Murder and Violent Offender Against Youth Registration Act.
20.
For at least one case, I received a Certificate of Eligibility for Sealing by the Prisoner
Review Board. (Attach a copy of the Certificate.)
21.
I am eligible to seal all eligible cases upon completion of my LAST sentence because
I received a high school diploma, associate's degree, career certificate, vocational or
technical certification, or bachelor's degree, or passed the high school GED Test; AND
a.
I did so during the period of my LAST sentence, aftercare release, or mandatory
supervised release; AND
EX-R 2903.6
Page 3 of 4
(07/21)
I I
Enter the Case Number given by the Circuit Clerk: _________________________________
Under the Code of
Civil Procedure, 735
ILCS 5/1-109, making
a statement on this
form that you know to
be false is perjury, a
Class 3 Felony.
If you are completing
this form on a
computer, sign your
name by typing it. If
you are completing it
by hand, sign and
print your name.
b.
I did not complete the same educational goal before.
c.
I have attached to this Request proof of the program I completed.
22.
I am eligible to seal all eligible cases upon completion of my LAST sentence because
I am a trafficking victim as defined under Section 10-9 of the Criminal Code of 2012, and
as such:
a.
I was a victim of human trafficking when my last offense was committed; AND
b.
My participation in the offense was a direct result of human trafficking under Section
10-9 of the Criminal Code of 2012 OR a severe form of trafficking under the federal
Trafficking Victims Protection Act.
23.
For at least one case, I received a conviction for Reckless Driving; AND
a.
I was under the age of 25 when the offense was committed; AND
b.
I have no other convictions for DUI or reckless driving; AND
c.
I have reached the age of 25.
I certify that everything in the Request To Expunge & Impound and/or Seal Criminal
Records is true and correct. I understand making a false statement on this form is perjury
and has penalties provided by law under 735 ILCS 5/1-109.
/s/
Your Signature
Date
Enter your complete
Prepared by:
address, telephone
number, and email
Attorney # (if any):
address, if you have
one.
Street Address:
City, State, ZIP:
DO NOT fill in the
Phone Number:
box to the right.
Email:
For official use only
State’s Attorney/Prosecutor/ISP/Arresting
Agency/Chief Local Legal Officer:
Received on:
GETTING COURT DOCUMENTS BY EMAIL: You should use an email account that you do not share with anyone else and that you check
every day. If you do not check your email every day, you may miss important information, notice of court dates, or documents from other parties.
EX-R 2903.6
Page 4 of 4
(07/21)
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REQUEST TO EXPUNGE & IMPOUND ANDOR SEAL CRIMINAL (Microsoft)

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Completed 16 August 2021

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