PIMA COUNTY CONSOLIDATED JUSTICE COURT STATE OF ARIZONA vs. ___________________________ 240 N STONE AVE. TUCSON, AZ 85701-1130 CASE NO. APPLICATION AND ORDER TO SET ASIDE JUDGMENT ACCUSATION & PENALTIES ________________________ APPLICATION This Application is made in conformance with the Arizona Revised Statutes and is addressed to the judge who pronounced sentence or imposed probation or to said judge's successor in office. Applicant ________________________ Address ____________________________________________________ Applicant is: Defendant Attorney for Defendant Probation Officer Offense(s): ___________________ Sentence Imposed: _____________ Date of Conviction: ____________ Place of Conviction: ____________ The undersigned states that Defendant has fulfilled the conditions of probation or sentence and was discharge by this Court. If the Application is sworn to by Defendant's Attorney or probation officer, either was authorized to do so as indicated by Defendant's signature below. Defendant, in connection with the above-captioned case, prays as follows, that: 1. The judgment of guilt to set aside. 2. The accusation or citation be aside. 3. Defendant be released from all penalties and disabilities resulting from the conviction, exept that the conviction may be pleaded and proved in any subsequent prosecution of Defendant for any offense as if the judgment of guilt had not been set aside. STATE OF ARIZONA ) ss. COUNTY OF PIMA ) Being duly sworn, I depose and say that I have read this Application and know and understand the contents therein; that the statements made in this Application are true and correct to the best of my knowledge, information, and belief. Date: _________________ SUBSCRIBED and SWORN to before me on: ________________________ Date ____________________________________________________ Clerk ____________________________________________________ (Affiant) Defendant / Attorney for Defendant / Probation Officer This Application is SET FOR HEARING as follows: DATE: _____________________ TIME: ___________ The Court, having read the foregoing Application, and in conformance with the statutes, being fully apprised of the premises, IT IS ORDERED: Granting the Application and further ordering: 1. That the judgment of Defendant's guilt be, and the same is, set aside. 2. That Defendant's accusation or citation be, and the same is, dismissed. 3. That Defendant be released from all penalties and disabilities resulting from the conviction or plea other than those imposed by the Department of Transportation pursuant to ARS §28-3304, 28-3306, 28-3307, or 28-3308, except that the conviction may be pleaded and proved in any subsequent prosecution of the defendant for any offense as if the judgment of guilt had not been set aside. Denying the Application for the following reason: ____________________________________________ _____________________________________________________________________________________. _______________________ Date JP165 (Rev 11-15-13)ec/kr ________________________________________ Judge Original-Court; Canary-Defendant/Defense American LegalNet, Inc. www.FormsWorkFlow.com