When you file this Application with the court, you must also file the Order form in this packet. (1) Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO In re the Application of: (3) Case Number: APPLICATION TO: (4) [ ] RESTORE CIVIL RIGHTS [ ] SET ASIDE A JUDGMENT (A.R.S. Title 13, Chapter 9) (2) Defendant, To Restore Civil Rights and/or Set Aside a Judgment (5) My Street Address: City, State, Zip: Phone Number: (6) Date I Was Convicted: Crimes for Which I Was Convicted: Date I Was Sentenced: Court That Sentenced Me: Judge Who Sentenced Me: (7) Date My Probation Began: Date of Court Order Ending My Probation: Date My Probation Ended: (8) I ask the court to restore the following of my civil rights: [ ] the right to possess a gun or firearm [ ] all other rights (9) [ ] I was sentenced for a felony in this court. [] I was discharged from probation. [] I was discharged from prison at least two years ago. A certificate of absolute discharge from the director of the state department of corrections is attached, or I was unable to get one because: (10) [ ] I was sentenced for a felony in federal court and I live in Coconino County. [] I was discharged from probation. An affidavit of discharge from the judge who discharged me is attached, or I was unable to get one because: Page 1 of 2 Revised April 2013 American LegalNet, Inc. www.FormsWorkFlow.com Coconino County Law Library and Self-Help Center Forms [] I was discharged from prison at least two years ago. A certificate of absolute discharge from the director of the federal bureau of prisons is attached, or I was unable to get one because: (11) If I'm asking the court to restore my right to possess a gun or firearm: [] I was not convicted of a dangerous or serious offense as defined by A.R.S. 13-105 and 13-706, and it has been at least two years since the date of my discharge from probation or absolute discharge from prison. I was convicted of a serious, but not dangerous, offense as defined by A.R.S. 13-105 and 13-706, and it has been at least ten years since the date of my discharge from probation or absolute discharge from prison. [] (12) [ ] I ask the court to set aside my judgment. (13) This court sentenced me for one or more crimes, and I have been discharged from: [ ] probation [ ] prison. No crime for which I was convicted is a crime listed in A.R.S. 13907(D). I have read this Application, and it is true and complete to the best of my knowledge. (14) State of Arizona County of Subscribed and sworn before me this date: Seal: Defendant's Signature: ) ) ) by: Notary Public: Notary Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Revised April 2013 Coconino County Law Library and Self-Help Center Forms