IN THE MATTER OF SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES JUVENILE COURT CASE #: JAI #: PETITIONER PETITION TO SEAL JUVENILE RECORDS AND COURT ORDER (Section 389 and 781 Welfare and Institutions Code) AGE: BIRTHPLACE: STATE: NAME OF ATTORNEY/AGENT REPRESENTING MINOR: MINOR'S NAME: ADDRESS: HEIGHT: WEIGHT: WILL REACH AGE OF 38 ON: PDJ #: MOTHER'S FIRST AND LAST MAIDEN NAME: SEX: CITY: BIRTHDATE: ZIP: DRIVER'S LICENSE NUMBER: DAYTIME TELEPHONE NUMBER: ( ) Petitioner requests that an order be made sealing all records, papers, exhibits in petitioner's case in the custody of the juvenile court, including the juvenile court record, case management/automated entries, and other records relating to the case in the custody of all agencies and officials named herein: INCIDENT NO. 1 2 3 4 5 6 7 8 9 10 11 12 DATE ARRESTING AGENCY VIOLATION(S) DISPOSITION Are there any civil lawsuits pending directly relating to or arising from the criminal act that caused your juvenile records to be created? q YES q NO If yes, list the name of the case, the case number, and the court district where the matter is being heard: _________________________________________________________________________________________________ Date:___________________________ _____________________________________________ SIGNATURE OF PETITIONER OR AGENT (IF AGENT, STATE RELATIONSHIP TO PETITIONER) COURT ORDER q The court has read and considered the probation report filed herein, and said report is admitted into evidence by reference. THE COURT RULES AS FOLLOWS: q q q q q q Adult criminal record has been established. q Insufficient time has elapsed due to seriousness of offense. Insufficient time has elapsed since termination of jurisdiction. Insufficient time has elapsed to prove rehabilitation of minor. The offense in incident(s) no.(s) ___________________ is listed pursuant to section 707(b) WIC and cannot be sealed. _____________________________________________________________________________________________ Date: _________________ _____________________________________________ JUDGE OF THE JUVENILE COURT THE PETITION IS DENIED FOR THE FOLLOWING REASONS: q THE PETITION IS GRANTED AS TO INCIDENT NO. (S) _______ AND DENIED AS TO INCIDENT NO.(S) _______ . q Reason for denial of Incident No.(s) _________________________________________________________________ q _____________________________________________________________________________________________ q THE PETITION IS GRANTED AS TO ALL INCIDENTS. q Any agency that has submitted records to FBI is ordered to recall same and seal accordingly. q Department of Juvenile Justice, Sacramento, California, is ordered to seal their records. Case number _____________ . q The Superior Court/Juvenile Division and Probation Department of _______________ County are ordered to seal their q The petitioner is relieved from the registration requirement under Penal Code 290, and the registration information in the q All sealed records are to be destroyed on (date): ________________________________________________________ . The clerk is directed to send a copy of this petition and order to each agency and official named therein, and each agency and official shall seal all records in its custody, related to this case(s), and shall advise the court of its compliance, and thereupon shall seal the copy of this petition and court order, pursuant to Welfare and Institutions Code sections 289 and 781, et. seq. Date: _________________ DLQ 003 (Rev. 07/16) records, their case number __________________ . custody of the Department of Justice and other agencies and officials listed in the petition shall be destroyed. _____________________________________________ JUDGE OF THE JUVENILE COURT American LegalNet, Inc. www.FormsWorkFlow.com