200-00132 – Stipulation to Expunge or Seal Criminal History Record + Order (01/2019) Page 1 of 2
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TIPULATION TO EXPUNGE OR SEAL CRIMINAL HISTORY RECORD
We, the undersigned Defendant and State’s Attorney, hereby agree that the offense(s) meet the requirements
for expungement or sealing pursuant to 13 V.S.A. §7602 and that the Court may issue an Order to:
☐ Expunge
☐ Seal
the criminal history record for the offense(s) described below:
Description of Offense Date of Offense Incident Number Docket Number (if any)
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
___________________________ _______________ _______________ _______________
☐ I was cited or arrested by (name of arresting law enforcement agency or department)
___________________________________________, but a charge was never filed with the Court.
We further understand that the effect of this Order will be to expunge or seal any records of arrest, conviction
or sentencing for this/these offense(s) and that the Defendant will hereafter be treated in all respects as if he
or she had never been arrested, convicted or sentenced for the offense(s).
Defendant:
_____________________________ _______________________________________
Date of Signature Signature
______________________________________________
Mailing Address
______________________________________________
City, State, Zip
____________________/__________________________
Phone Email
State’s Attorney:
_____________________________ ______________________________________
Date of Signature Signature
