Free CCCR 0011 1-17-01 - Illinois

THIS FORM IS TO BE USED FOR CASES INVOLVING ACQUITTAL, RELEASE WITHOUT CONVICTION OR FOR CASES INVOLVING A SENTENCE OF SUPERVISION FOR CHARGES NOT SPECIFIED IN 20 ILCS 2630/5(a)
(This form replaces CCG 0056)

(Rev. 7/15/08) CCCR 0011

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS THE PEOPLE OF THE STATE OF ILLINOIS or A MUNICIPAL CORPORATION v.

____________________________________________________ Defendant/Petitioner

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Case No(s).

______________________________ ______________________________ ______________________________ ______________________________ ______________________________

Charge(s): _____________________________________________________________________________________________________

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Date(s) of Arrest(s): _____________________________________________________________________________________________

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Arresting Authority(ies) __________________________________________________________________________________________

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_____________________________________________________________________ I. D. No. _____________________________________
(ISB, IR, FBI, DCN)

Date of Birth: _____________________________ Sex: _________________ Return Records to Petitioner at:

Race: ______________________________________

Address: ___________________________________________________________________________________________________________ City/State/Zip: _______________________________________________________________________________________________________ PETITION TO EXPUNGE The above named Defendant/Petitioner states under oath, that: The Petitioner was arrested by the Arresting Authority(ies) on the date(s) and for the offense(s) stated above. (a) The Petitioner was released without being convicted or, (b) The Petitioner was released without being convicted following a sentence of supervision and it has been two (2) years since discharge and dismissal of that supervision. 3. The Petitioner has not previously nor has s/he subsequently been convicted of any criminal offense or any municipal ordinance violation, including violations of 625 ILCS 5/4-400 and 5/11-204.1, formerly Chapter 4, and Section 11-204.1 of the Illinois Vehicle Code, and s/he has not since been arrested for any such offense and there are no criminal charges pending against him/her at the present time. 4. Under penalties provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned Petitioner certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned Petitioner certifies as aforesaid that s/he believes the same to be true. WHEREFORE, the Petitioner asks the Court to expunge his/her arrest records and return the same to Petitioner at the address shown above. Dated: ____________________________________, ________ ___________________________________________________ Defendant/Petitioner Prepared by: ___________________________________ Atty. No.: Address: 1. 2.

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Received this _______ day of ___________________, ________

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City/State/Zip: ___________________________________ Telephone:

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State's Attorney or Prosecutor

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS