JD-JM-12 Rev. 10-15 C.G.S. §§ 46b-120; 46b-133a; 46b-146 P.A. 15-195 § 3 P.B. §§ 27-4(A); 27-8A(c); 27-9(c) ERASURE OF RECORD PETITION/ORDER STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Instructions To Person Asking To Have Record Erased Complete Section I below, sign it in front of a notary public, an assistant clerk of the Superior Court, or a Commissioner of the Superior Court, and file the original with the court. Keep a copy for yourself. Instructions To Court Staff Send a copy of the signed order to all depositories of police and court records pertaining to the charge of delinquency or that a child is from a family with service needs. ADA Notice The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. Address of Court Name of Child Police Department Date of Birth Docket Number Date of Disposition/Discharge Police Department Case Number Section 1 -- Petition For Erasure Of Record I respectfully request that the court erase all police and court records about the child named above. I swear to the following facts: At least 2 (two) years or, in the case of a serious juvenile offense conviction, 4 (four) years have passed · from the date the child was discharged from the supervision of the Superior Court or · the child was discharged from the custody of the Department of Children and Families or · the child was discharged from the care of any other institution or agency the child was admitted to by the court and · no other juvenile proceeding or adult criminal proceeding is pending against the child, and · the child has not been convicted of a delinquent act that would constitute a felony or misdemeanor if committed by an adult during the 2 year or 4 year period, and · the child has not been convicted as an adult of a felony or misdemeanor during the 2 year or 4 year period, and · that the child has reached age 18. OR The child has a record because of being a victim of trafficking. I request a hearing in order to show that there is good cause to erase the records before the statutorily required time period expires. Date of Petition Signed (Petitioner (Child/Parent/Guardian, or Attorney)) Date Address of Petitioner Subscribed and Sworn to before me: Signed (Notary Public, Assistant Clerk, Commissioner of the Superior Court ) Granted, all police and court records about the child are erased under section 46b-146 of the General Statutes. Denied. By the Court (Print or type name of Judge) Signed (Judge/Clerk/Assistant Clerk) Date Signed American LegalNet, Inc. www.FormsWorkFlow.com Section 2 -- Order For Erasure By Operation Of Law Under the provisions of section 46b-146 of the Connecticut General Statutes The charge(s) of delinquency that a family is a family with service needs (FWSN) arising out of the petition(s)/information(s) in the matter of the child named above was (were) dismissed. Under the provisions of section 46b-133a(b) of the Connecticut General Statutes The child named above was charged with delinquency and 13 months have elapsed since: a nolle prosequi has been entered as to the charge(s) in the petition(s)/information(s) OR the charge(s) in the petition(s)/information(s) has/have been dismissed without prejudice. Under the provisions of section 27-8A(c) of the Connecticut Practice Book the child has successfully completed nonjudicial delinquency handling and the matter is dismissed and erased for all purposes except later consideration for nonjudicial handling under section 27-4A of the Connecticut Practice Book. Under the provisions of section 27-9(c) of the Connecticut Practice Book the child has successfully completed a diversion to FWSN services under section 46b-149(g) of the Connecticut General Statutes and the matter is dismissed and erased for all purposes except subsequent consideration for nonjudicial handling under section 27-4A of the Connecticut Practice Book. Now, therefore, it is ordered that all police and court records pertaining to such charge(s) are erased. By the Court (Print or type name of Judge) On (Date) Signed (Judge/Clerk/Assistant Clerk) Date Signed Notice to Depositories of Police and Court Records Upon the entry of such an erasure order, all references including arrest, complaint, referrals, petitions, reports and orders shall be removed from all agency, official and institutional files, and a finding of delinquency or that the child was a member of a family with service needs shall be deemed never to have occurred. The persons in charge of such records shall not disclose to any person information pertaining to the record so erased, except that the fact of such erasure may be substantiated where, in the opinion of the court, it is in the best interests of such child to do so. American LegalNet, Inc. www.FormsWorkFlow.com