Free Expungement Form - Missouri

In the

CLEAR FORM

CIRCUIT COURT


For File Stamp Only



Of St. Louis County, Missouri
_____________________________________________ Plaintiff vs. Defendant(s)/ Agency(ies) to be notified:
CIRCUIT COURT DIVISION ASSOCIATE COURT DIVISION MUNICIPAL COURT DIVISION DIVISION

CASE NUMBER

COURT ORI NUMBER Check & Complete all that apply:

095015J


ST. LOUIS COUNTY POLICE DEPT.



___________________________ ___________________________ ___________________________

_____________________________ POLICE DEPT.

MISSOURI HIGHWAY PATROL TROOP_________ CRIMINAL RECORDS REPOSITORY

PROSECUTOR'S OFFICE (INCLUDE NAME OF COUNTY OR CITY) OF:
ST. LOUIS COUNTY PROSECUTOR'S CITY/ VILLAGE OF_________________________ PROSECUTOR'S

OTHER (INCLUDE NAME AND LOCATION OF AGENCY) ______________________________________________ ______________________________________________

PETITION FOR EXPUNGEMENT OF ARREST RECORDS
Pursuant to Section 610.122, RSMo, I request that the court issue an order to expunge my record of arrest, for the criminal case described below: I am filing this petition in the county where the arrest occurred and I hereby swear that I have no prior or subsequent misdemeanor or felony convictions and I did not receive a suspended imposition of sentence (SIS) for the offense for which the arrest was made or for any offense related to the arrest. I also state that the arrest was based on false information, there is no probable cause at the time of the action to expunge to believe that I committed the offense and no charges will be pursued as a result of the arrest, and no civil action is pending relating to the arrest or the records sought to be expunged. Pursuant to Section 610.123, RSMo, I have attached the petitioner's fingerprints on a standard fingerprint card, and I have reason to believe the agencies named above as defendants may possess records subject to expungement.
FULL NAME DATE OF BIRTH SOCIAL SECURITY NUMBER SEX M F RACE

DRIVER'S LICENSE NUMBER OFFENSE CHARGED

ADDRESS AT TIME OF ARREST

DATE OF ARREST

ARREST CITATION NUMBER

IF CRIMINAL CHARGES WERE FILED, DATE OF DISMISSAL OR REVERSAL NAME OF ARRESTING AGENCY

COUNTY WHERE PETITIONER WAS ARRESTED (IF ARREST OCCURRED IN
A MUNICIPALITY, ALSO NAME MUNICIPALITY)

CASE NUMBER AND DIVISION OF COURT OF THE OFFENSE

CIRCUIT

ASSOCIATE

MUNICIPAL

DIVISION__________

#________________________________________________________________

NOT APPLICABLE

I, plaintiff, swear the facts stated in the above petition are true according to my best knowledge and belief. ______________________________________________________ Plaintiff's Signature is required / Address _________________________________________________________ _________________________________________________________ Attorney for Petitioner MBE#

Subscribed and sworn to before me this____________ day of ____________________________, _______________. __________________________________________________ Notary Public/ Judge/ Clerk My Commission expires: __________________

__________________________________________________________; ____________________________________________________ Address
CCCM70 Rev. 08/03 WHITE - File YELLOW - Agency 1 PINK - Agency 2 GOLDENROD - Petitioner