Free ORDER FOR THE EXPUNGEMENT OF CRIMINAL OFFENDER RECORD - Tennessee

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ORDER FOR THE EXPUNGEMENT OF CRIMINAL OFFENDER RECORD

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State of Tennessee vs _______________________________________________ Circuit Docket Number_______________________ Date Original Case was filed in Clerk's Office___________________ General Sessions Docket Number_______________________ In the ____________________Court of __________________________ County, Tennessee at _______________________________ On the Motion or Petition of ______________________________________________________ Defendant/Arrest Information: _________________________________________________________________________ Defendant (name used at time of arrest) ________________________________________________________________ Arresting Agency ___________________________________________________________________ Charge 1(As shown on arrest fingerprint card) _____ Race ____ Sex ___________ Date of Birth

_____________ __________________ OCA# Date of Arrest ________________________________ SSN#

________________________________________________________________________________________________________ Charge 2(As shown on arrest fingerprint card) ________________________________________________________________________________________________________ Charge 3(As shown on arrest fingerprint card) Disposition Information: ________________________________________________________________________________________________________ Final Charge 1 ________________________________________________________________________________________________________ Final Charge 2 ________________________________________________________________________________________________________ Final Charge 3 ________________________________________________________________________________________________________ Final Disposition ________________________________________________________________________________________________________ Diversion Date (if applicable)
The defendant named above is entitled to have all PUBLIC RECORDS relating to the offenses listed above expunged according to the Tennessee Code Annotated provision marked below: Provision relating to Adults: ___Charge has been dismissed (T.C.A. § 40-32-101) ___No true bill returned by Grand Jury (T.C.A. § 40-32-101) ___Verdict of not guilty returned by jury (T.C.A. § 40-32-101 ___Conviction which has by appeal been reversed (T.C.A. § 40-32-101) ___Nolle Prosequi entered in case (T.C.A. § 40-32-101) ___Successful completion of all probation provisions and proceedings against defendant have been discharged by the court (T.C.A. § 40-35-313) ___Suspension of prosecution pursuant to T.C.A. § 40-15-105 Provisions relating to Juveniles: ___Petition alleging delinquency not filed (T.C.A. § 37-1-155) ___Proceedings dismissed after petition is filed or the case transferred to Juvenile Court as provided in T.C.A. § 37-1-109 (T.C.A. § 37-1-155) ___Adjudicated not to be a delinquent child (T.C.A. § 37-1-155) ___Child has reached eighteen (18) years of age and there is no record that he committed a criminal offense after reaching sixteen (16) years of age, unless such fingerprints were obtained on alleged charge which if committed by an adult would be a felony (T.C.A. § 37-1-155) ___Passage of six (6) months from date of liquor law violations defined by T.C.A. § 57-3-412(a)(3)(c) or T.C.A. § 57-5-301(e)(3)

It is ordered that all PUBLIC RECORDS relating to such offense above referenced be expunged and immediately destroyed upon payment of all costs to clerk and that no evidence of such records pertaining to such offense be retained by any municipal, county, or state agency, except non-public confidential information retained in accordance with T.C.A. § 10-7-504 and T.C.A. § 38-6-118. APPROVED FOR ENTRY

________________________________________________ Defendant/Attorney for Defendant ________________________________________________ District Attorney General

Entered this ______________ day of _______________, _______

__________________________________________________________ Judge

Form EX-1 (Rev. 2003)