Free PETITION FOR EXPUNGEMENT OF RECORD - Utah

District Court ________________ County, State of Utah

______________________________ Petitioner ______________________________ Address ______________________________ Phone Number ______________________________ Birthdate Petitioner.

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PETITION FOR EXPUNGEMENT OF RECORD

Case No. _________________

Judge ____________________

Petitioner petitions this Court for an order of expungement of any and all records relating to the following offense: 1. Petitioner was arrested on ___________, 20__ by __________________ (law enforcement agency) under law enforcement file number_________ for the following crime(s) and/or charge(s), (with the appropriate code or ordinance citation), arising out of the same criminal episode: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ filed under the following case number(s):_________________________________________ ________________________________________________________________________ _____________________________________________________________________________ 2. With regard to the crime(s) and/or charge(s), the following has occurred (check a, b or c, and all other appropriate boxes): ( ) a. 30 days have passed since arrest, there have been no intervening arrests, and one of the following has occurred: ( ) Petitioner was released without the filing of formal charges ( ) Proceedings against Petitioner were dismissed on ____________________________________________________ () Petitioner was discharged without a conviction and no new charges were filed within 30 days ( ) The Petitioner was acquitted at trial

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( ) b. 30 days have not passed since the time of arrest, but the following extraordinary circumstances exist for granting the expungement: _________________________________________________________ _________________________________________________________ ( ) c. Petitioner was convicted in this Court on __________, 20__, for the crime(s) of _______________________________________________ ________________________________________________________ ___________________________________________________________ Pursuant to Utah Code Ann. § 77-18- 12, Petitioner has obtained an expungement certificate from the Law Enforcement and Technical Services Division of the Department of Public Safety (the Utah Bureau of Criminal Identification), which is attached to this petition and which shows that Petitioner is eligible to have the conviction expunged. Check one of the following: ( ) Petitioner requests that all records in the petitioner's case be expunged ( ) Petitioner requests that only the following records be expunged: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ( ) Petitioner requests that only petitioner's name be expunged from all records Dated this ____ day of ______________ 20__. ______________________________________ Counsel for Petitioner/Pro Se Petitioner

Mailing Certificate I certify that I have served (either by first class mail or hand delivering) Petitioner's Petition for Expungement of Records, and the expungement certificate issued by the Law Enforcement and Technical Services Division of the Department of Public Safety, to the prosecuting attorney and the Department of Corrections at the following addresses:

________________________________ ________________________________ ________________________________

________________________________ Signature

District Court ________________ County, State of Utah

______________________________ Petitioner ______________________________ Address ______________________________ Birthdate Petitioner.

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ORDER FOR EXPUNGEMENT OF RECORD

Case No. _________________ Judge ____________________

The Court having reviewed Petitioner's Petition for Expungement of Records and having found as follows: 1. That Petitioner was arrested on _________________ (date) by ________________ _______________ (law enforcement agency) for the following charges:____________________ _______________________________ filed under the following case number(s):_____________________________________________________; 2. The Petitioner has met all of the conditions for expungement and the Court is satisfied that there are no reasonable objections to Petitioner's petition; IT IS HEREBY ORDERED: 1. ( ) All records in Petitioner's case in the custody of this court, any other court, or any state, county or local entity, agency or official, as identified in the above petition, shall be sealed pursuant to Utah Code Ann. § 77-18-14. OR ( ) The following records in Petitioner's case shall be expunged: ____________________________________________________________ ____________________________________________________________ ( ) References to Petitioner's name shall be removed from records in Petitioner's case in the custody of this court, any other court, or any state, county or local entity, agency, agency or official pursuant to Utah Code Ann. § 77-18-14. 2. Petitioner shall distribute this order to all affected agencies and officials including the arresting agency, the booking agency, the prosecutor's office, the Department of Corrections, the Law Enforcement and Technical Services Division of the Department of Public Safety (the Utah Bureau of Criminal Identification), the Board of Pardons, and all interested courts. Dated this _____ day of _____________, 20__. _______________________________ COURT JUDGE

District Court ______________ County, State of Utah

______________________________ Petitioner ______________________________ Address ______________________________ Birthdate Petitioner.

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RECEIPT, CONSENT AND WAIVER OF HEARING

Case No. _________________ Judge ____________________

The undersigned acknowledges receipt of a copy of Petitioner's Petition for Expungement. The undersigned waives the right to object to Petitioner's Petition and consents to this court entering an Order for Expungement of Records without further hearing. Dated this _____ day of _____________, 20__. _____________________________ Prosecutor

District Court ______________ County, State of Utah

______________________________ Petitioner ______________________________ Address ______________________________ Birthdate Petitioner.

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NOTICE TO SUBMIT FOR DECISION

Case No. _________________ Judge ____________________

Petitioner filed a Petition for Expungement and Sealing of Record on _____________, 20__, along with an expungement certificate issued by the Law Enforcement and Technical Services Division of the Department of Public Safety. These documents were served upon the prosecuting attorney and the Department of Corrections more than 30 days ago and the prosecuting attorney has not objected to the petition or requested a hearing. The court has not received a request for hearing from any victim and therefore Petitioner requests that this Court grant Petitioner's petition and execute the accompanying Order, or set forth its reasons for denying to do so. Dated this _____ day of _____________, 20__. _________________________________ Counsel for Petitioner/Pro Se

Mailing Certificate I certify that I have mailed the Notice to Submit for Decision on Petitioner's Verified Petition for Expungement and Sealing of Records to the prosecuting attorney at the following address:

________________________________ ________________________________ ________________________________

_____________________________ Signature