Free Petition Form for Sealing Conviction and Aged-Out Cases - Massachusetts

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PETITION TO SEAL
TO:
PART A
1 - 4

Commissioner of Prohation, One Ashburton Place, Fm.405, Boston MA 02108
I f 1. 2, or 3 are selected you must sign corresponding numbered affidavit below.

SELECT appropriate box(es).

Section 1008 - Chapter 276. Delinquency (juvenile) cases, all sentence elements of which, and of any subsequent court appearances, were completed 3 years prior to this request. Section lOOA - Chapter 276. Misdemeanor cases, all sentence elements of which, and of any subsequent court appearances, were completed 10 years prior to this request (or, which was a felony when committed, and is presently a misdemeanor) .

Petition to corn. Of Probation

3

Section lOOA - Chapter 276. Felony cases, all sentence elements of which, and of any subsequent court appearances, were completed 15 years prior to this

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First name

Section l O O A - Cha ter 216. Recorded offense which is no longer a crime, except where the eyements of the offense continue to be a crime under a different designation.

Print Last name Middle name Alias/Maiden/Previous name Mailing Address Occupation Birthplace Father's Name Husband or Wife Signature Mothers Maiden Name City

Date of Birth

State Social Security W

Zip

100A, as established by ter Acts of OF rovision of Chapter 276, Sections ofcourtand 1008. 1973, respectively.Cha{ereby ed of thethat my the Acts of 1972 and Chapter 322 the Acts of I request record of adult criminal and/or juvenile Massachusetts appearances and dispositions be sea orthwith.
686

In accord with the

1971. Chapter 404

To the best of my knowledge:
a) My delinquency court appearances or dispositions including court supervision, probation, commitment or parole, the records for which are to be sealed, terminated not less than lhree years prior to said request: b) I have m t been adjudicated delinquent or found guilty of any criminal offense within the commonwealth in the three years preceding such request. except motor vehicle offenses in which the penalty does not exceed a fine of fifty dollars nor been imprisoned under sentence or committed as a deli ent within the commonwealth within the preceding three years; and c) I have not been adjudicated delinquent or found guilty of any c r i m i ~ o f f e n s e s any other slate, United States in possession or in a court of federal jurisdiction. except such motor vehicle offenses as aforesaid, and have not been imprisoned under sentence or committed as a delinquent in any state or county within the preceding three years. Signed under penalties of perjury,

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Signature of petitioner
2.

To the best of my knowledge:
a) All of my court appearance and court disposition records. including termination of court supervision. probation. or sentence for any misdemeanor occurred not less than ten years prior to this re uest; b) that my court appearance and court disposition records. including termination of coun sumrvision. orohtion or sentence for anv fe?onv occurrexi no( less b n s f t e e n vean orior to this reauest: c) that I have not been found guilty df any crihinal offense within the co&onwdth in ihe ten years preceding s k h r$est. except mbtor vehicle offenses in which the plcnalty docs mt exceed a f i o[ fib dollars; d) 1 have not been convicted of any criminal o ewe in any other state, U@ted ~ States possession or in a cowl of f d e n l junsdimo, except such motor velude offenres ?s aforesaid. and have-not k e n imprisoned in any slate or county within the preceding ten years: and e) my m r d docs not include convictiom of o f f e m other than those to which the section applies. or convictions for violations of sections ow hundred and twenty-one to one hundredhirty one H, inclusive. of chapter one hundred and forty or for violations of chapter two hundred a d sixty eight or chapter two hundred and sixtyzight A.

Signed under penalties of perjury.

SignaNre of petitioner

PETITIONER NOT TO WRITE BELOW THIS LINE Petition Allowed/Dlsallowed 01 Allowed (Co y to C l e r k a n d Probation Office1 Reason for gisallowance ( C o p y to petitloner only1
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