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FACTS PERTAINING TO EXPUNGEMENT MATTER ________:
CONVICTION FOR A FELONY THAT DID NOT RESULT IN SERIOUS BODILY INJURY
1. Petitioner was arrested in _______________________ County on __________________ by
_________________________ employed by the law enforcement agency known as _____________________________
under law enforcement agency case number _________________________;
2. P
etitioner was convicted on the following charges on _____________________________, under Cause Number
________________________________ in __________________ _________________ Court, Criminal Division,
Room__________.
Title
Class
Count
Category
a.
b.
c.
d.
3. P
etitioner is not a person who is prohibited from seeking this remedy under the provisions of I.C. §35-38-9-4(b).
4. El
apsed time:
Eight (8) years have passed between the date of Petitioner’s conviction and the filing of this Petition.
Three (3) years have passed between the date of completion of Petitioner’s sentence, on
_______________________________, and the filing of this petition.
The period of time required under IC § 35-38-9-4(c) has not passed, but the _______________________County
Prosecuting Attorney has provided written consent for a shorter elapsed time period (see Exhibit _____
attached, letter of consent from __________________________ County Prosecutor).
5. Cr
iminal activity within the previous eight (8) years:
Petitioner affirms that to the best of their knowledge, they have not committed another crime in any jurisdiction
within the previous eight (8) years.
Petitioner affirms that, to the best of their knowledge, they have not committed another crime in any jurisdiction
within the shorter elapsed time period to which the prosecuting attorney has agreed.
6. P
etitioner has:
Paid all fines, fees, and court costs, and no restitution obligation was imposed as part of their sentence
Satisfied their restitution obligation of $_____________________ imposed as part of their sentence.
Been found indigent as to all outstanding fines, costs, and fees ordered as part of their sentence.
7. Ap
pellate activity:
The case that Petitioner is requesting be sealed has not been appealed.
The case that Petition is requesting be sealed was appealed on ______________________ under the following
appellate cause number _____________________________.
8. Rel
ated MC cause numbers:
Court records stored under the following MC case/cause numbers constitute records of the sentencing court or
juvenile court for the purposes of this order:
__________________________________________________________________________________________
__________________________________________________________________________________________
____
________
_________
___________
_________
___________
_________
___________
_________
___________
_______
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NOT PUBLIC RECORD
FINDINGS PERTAINING TO EXPUNGEMENT MATTER ________:
CONVICTION FOR A FELONY THAT DID NOT RESULT IN SERIOUS BODILY INJURY
The
Court now finds by a preponderance of the evidence that:
1. P
etitioner’s verified petition for expungement seeks relief as provided by I.C. §35-38-9-4 for a conviction on a
Class D felony offense that did not result in bodily injury, entered on the following charges on
____________________________, under Cause Number ______________________________________ in
__________________ _________________, Court, Criminal Division, Room ___________.
Title
Class
Count
Category
a.
b.
c.
d.
2. P
etitioner is not a person who is prohibited from seeking this remedy under the provisions of IC §35-38-9-4(b).
3. El
apsed time:
Eight (8) years have passed between the date of Petitioner’s conviction and the filing of this Petition.
Three (3) years have passed between the date of completion of Petitioner’s sentence, on
_______________________________and the filing of this Petition.
The period of time required under IC § 35-38-9-4(c) has not passed, but ____________________ County
Prosecuting Attorney has provided written consent for a shorter elapsed time period (see Exhibit _____
attached, letter of consent from __________________________ County Prosecutor).
4. Cr
iminal activity within the previous eight (8) years:
Petitioner has not been convicted of another crime in any jurisdiction within the previous eight (8) years.
Petitioner has not been convicted of another crime in any jurisdiction within the shorter elapsed time period to
which the prosecuting attorney has agreed.
5. P
etitioner has:
Paid all fines, fees, and court costs, and no restitution obligation was imposed as part of their sentence
Satisfied their restitution obligation of $_____________________ imposed as part of their sentence.
Been found indigent as to all outstanding fines, costs, and fees ordered as part of their sentence.
6. Appellate activity:
The case that Petitioner is requesting be sealed has not been appealed.
The case that Petition is requesting be sealed was appealed on ______________________ under the following
appellate cause number _____________________________.
7. Rel
ated MC cause numbers:
Court records stored under the following MC case/cause numbers constitute records of the sentencing court or
juvenile court for the purposes of this order:
__________________________________________________________________________________________
_________________________________________________________________________________________
8. The facts and circumstances pertaining to both Petitioner’s prior criminal conduct and Petitioner’s current
lifestyle warrant the expungement of the conviction records listed in EXPUNGEMENT MATTER _____of this
Petition.
The court now finds that the Petition as to EXPUNGEMENT MATTER ______ shall be GRANTED.
NOT PUBLIC RECORD
____
________
_________
___________
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___________
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___________
_________
___________
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NOT PUBLIC RECORD
EXHIBIT A, Page _____ of _________:
FINDINGS AND ORDER GRANTING PETITION FOR EXPUNGEMENT OF CONVICTION RECORDS
PURSUANT TO I.C. §35-38-9 (XP Cause Number: ________________________________________)
EXPUNGEMENT MATTER _______,
PETITIONER IDENTIFICATION INFORMATION:
Full
Name: ____________________________________ Alias Names, DOBs and SSNs:
DOB: ________________________________________ ______________________________________
SSN: ________________________________________ ______________________________________
______________________________________
Addresses since arrest:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
INDIVIDUAL ARREST INFORMATION:
Criminal Cause Number: _______________________________________
Related MC cause/case numbers:
________________________________________________________________________________________________
________________________________________________________________________________________________
Arre
sting Agency: ____________________________________________
County/City of Arrest: _________________________________________
Law Enforcement Agency Case Number: __________________________
Date
of Arrest: ____________________ Date of Conviction: ______________________
List o
f Charges: Disposition of Charges:
Expunged pursuant to I.C. § 35-38-9-6
Expunged pursuant to I.C. § 35-38-9-7
NOT expunged
NOT PUBLIC RECORD
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_________________
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_________________
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_________________
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_________________
_________
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_________________
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_________________