Petition to Expunge Records - Conviction App roved Board of District Court Judges October, 2012 Revised May 8, 2018 Page 1 of 2 Name Address City, State, Zip Phone Email I am the [ ] Petitioner [ ] Attorney for the Petitioner and my Utah Bar number is In the [ ] District [ ] Justice Court of Utah Judicial District County Court Address In Re : Petitioner Petition to Expunge Records (C onviction) Case Number Judge (1) Conviction record. I was convicted of a crime or crimes in court case number . (2) Certificate of eligibility. The attached certificate of eligibility is offered as proof of my eligibility for expungement of the crime(s). (3) Public interest. The following explains why expunging the crime(s) is not contrary to the public interests. American LegalNet, Inc. www.FormsWorkFlow.com Petition to Expunge Records - Conviction App roved Board of District Court Judges October, 2012 Revised May 8, 2018 Page 2 of 2 (4) Request. I request that the court order expungement of the crime(s) identified above, and order state, county and local government agencies to expunge related records in their possession or control. I declare under criminal penalty under the law of Utah that everything stated in this document is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com