IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT STATE OF OREGON, ) AFFIDAVIT IN SUPPORT OF MOTION Plaintiff, ) TO SET ASIDE CONVICTION AND SEAL v. ) RECORDS OF ARREST _________________________________________, ) Defendant. ) Case No. _________________________ STATE OF OREGON ) ) ss COUNTY OF MARION ) I, __________________________________, do hereby depose and say that: I am the Defendant herein, and I am filing this Affidavit in Support of my Motion to Set Aside Conviction and to sealthe records of my arrest. This conviction occurred more than three (3) year ago. I have no criminal cases presently pending against me in anycourt. I have no criminal convictions in the ten (10) year period immediately preceding the filing of this motion,excluding motor vehicles violations. I have not had another conviction set aside within the ten (10) year periodimmediately preceding the filing of this Motion and have no other similar motions pending in this or any other court. I have fully complied with and performed all provisions of the sentence herein. A copy of this Affidavit and a copy of my Motion to Set Aside Conviction and Seal Records of Arrest have beenserved upon the District Attorney of Marion County. A complete set of my fingerprints, along with a certified check made payable to the Oregon State Police for theirprocessing costs, has been served on the District Attorney of Marion County. I am not now charged with the alleged commission of any crime. The arrest that I am seeking to have set aside occurred on ____________________________. The charge(s) that I was arrested for on the above date was (were)_________________________________________________________________________________________________________________________________________ Arresting agency and incident number ______________________________________________________. The charge(s) that I was convicted of was (were) ______________________________________________. The date of my conviction was ___________________________________ This conviction was not a Class A felony, or a Class B felony (excluding possession or delivery of a controlledsubstance). Dated: ______________________________ ________________________________________ Signature of Defendant SUBSCRIBED AND SWORN TO before me this _______ day of _______________________, ________. ______________________________________ Deputy Clerk of Court/Notary Public of Oregon My Commission Expires: ________________AFFID AV IT IN SUPPOR T OF MOTION TO SET A SIDE CONV ICTION AND SEA L RE CORD S OF ARR EST - Page 1 of 1 FC(11/10/03)