Page 1 of 2 Revised August 2017 251 2017 Coconino County Law Library (1) Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self COCONINO COUNTY SUPERIOR COURT In re the Application of : (2) Defendant, To Restore Civil Rights and/or Set Aside a Judgment (3) Case N umber: O RDER: (4) [ ] RESTORING CIVIL RIGHTS [ ] SETT ING ASIDE A JUDGMENT (A.R.S. Title 13, Chapter 9) (5) Date Defendant Was Convicted: Crimes for Which Defendant Was Convicted: Date Defendant Was Sentenced: Court That Sentenced Defendant : Judge Who Sentenced Defendant : (6) Defendant has been discharged from: [ ] probation [ ] prison. Defendant has met the statutory requirements for the following order(s): [ ] The following of s, suspended due to the conviction above, are restored: [ ] The right to vote [ ] The right to hold public office of trust or profit [ ] The right to serve as a juror [ ] Any other rights, other than the right to possess a gun or firearm, which were suspended during imprisonment [ ] The right to possess a gun or firearm which was suspended pursuant to A.R.S. 13-904 [ ] judgment of guilt is set aside, the accusations or information is dismissed, and Defendant is released from all penalties and disabilities resulting from the conviction other than those imposed by the department of transportation pursuant to A.R.S. 28-3304, 28-3306, 28-3307, or 28-3308, except that the conviction may be used as a conviction if it would be admissible had it not been set aside and may be pleaded and proved in any subsequent prosecution of Defendant by the state or any of its subdivisions for any offense or used by the department of transportation in enforcing the provisions of A.R.S. 28-3304 or 3306-8 as if the judgment of guilt had not been set aside. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Revised August 2017 251 2017 Coconino County Law Library [ ] Defendants application is denied. Date: Superior Court Judge/Justice of the Peace/Magistrate (Presiding Superior Court Judge if the conviction was in the U.S. District Court) American LegalNet, Inc. www.FormsWorkFlow.com