JDF 313 (a) R 3 - 1 8 PETITION TO SEAL PURSUANT TO 247 18 - 13 - 122(10), C.R.S. (AS IT EXISTED PRIOR TO JULY 1, 2014) Page 1 of 1 County Court County, Colorado Court Address: State of Colorado v. Defendant : COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION TO SEAL RECORDS RELATED TO ILLEGAL POSSESSION OR CONSUMPTION OF ETHYL ALCOHOL BY AN UNDERAGE PERSO N (MIP) PURSUANT TO 247 18 - 13 - 122(10) , C.R.S. (AS IT EXISTED PRIOR TO JULY 1, 2014) I, , ( Name of Defendant), petition th is C ourt to seal records related to the above - captioned case involving illegal possession or consumption of ethyl alcohol by an underage person . 1. Information about the Defendant: Date of Birth: Current Mailing Address: City , State and Zip Code: Home Phone #: Work Phone #: Cell #: 2. I request that the following information be sealed: Date of Offense Name of Law Enforcement Agency Arrest /Summons Number 3. One year has passed since : the date of my conviction, the date my case was dismissed, the date I completed my deferred judgment, or the date my deferred prosecution concluded , for a violation of 247 18 - 13 - 122(2), C.R.S. (as it existed prior to July 1, 2014) ; whichever is later . 4. I have not been arrested for, charged with, or convicted of any felony, misdemeanor, or petty off ense during the one year period following the date of my conviction for a violation of 247 18 - 13 - 122(2), C.R.S . (as it existed prior to July 1, 2014). By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE (Printed name of Petitioner/Defendant) Signature of Petitioner/Defendant Date Signature of Attorney Date American LegalNet, Inc. www.FormsWorkFlow.com