L-500 PETITION TO SEAL COURT / ARREST RECORDS Penal Code 851.90 and 851.91 Revised 01/24/2019 Page 1 of 2 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address.) Telephone No.: Bar No. Facsimile No.: E-Mail address:ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Drive West, Santa Ana, CA 92701 Harbor - 4601 Jamboree Road, Newport Beach, CA 92660 North - 1275 N. Berkeley Avenue, Fullerton, CA 92838 West - 8141 13th Street, Westminster, CA 92683 PE O PLE OF THE STATE OF C A LIFORNIA vs. D EFENDA N T: PETITION TO SEAL COURT / ARREST RECORDS CASE NUMBER The petition must be completed in its entirety and served upon the Prosecuting Attorney and Arresting Agency prior to filing with the court. Hearing date and department must be set in accordance with court guidelines. 1.The petition will be heard on at in Department at the address listed above. 2.Information relating to the arrest / filing: Last First M iddle Name: Date of Birth: Driv e r 222s L i c en s e No: Date of Arrest: Arre s t ing Agen c y : City and County of Arrest City: County: Booki n g N um ber: Police Report Number : Charge ( s ) : 3.I am entitled to have my arrest sealed as a matter of right: a.No complaint was filed. The statute of limitations has run on every offense upon which the arrest wasbased and the prosecutor has not filed an accusatory pleading based on the arrest. b.A complaint was filed. The charge(s) have been dismissed and charges may not be refiled. c.A complaint was filed. No conviction occurred and I have been acquitted of all charges. d.Pursuant to Penal Code 247 1000.4 & 1001.9. 4.I am requesting that my arrest be sealed in the interest of justice for the reasons noted below: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATE TYPE OR PRINT NAME SIGNATURE OF PETITIONER DATE TYPE OR PRINT NAME OF ATTORNEY SIGNATURE OF ATTORNEY American LegalNet, Inc. www.FormsWorkFlow.com L-500 PETITION TO SEAL COURT / ARREST RECORDS Penal Code 851.90 and 851.91 Revised 01/24/2019 Page 2 of 2 C a se N ame: Ca s e Number: PROOF OF SERVICE Personal Service Service by Mail 1.Person serving: I am over the age of 18 and not a party to this action.Name:Address: Telephone: 2.I served a copy of the Petition and Order to Seal and Destroy Arrest Records as follows (check one): a. Personal Service: I personally delivered the Petition and Order to Seal and Destroy Arrest Records tothe person at the address listed below: b. Law Enforcement Agency:Address where served:Date served:Time served States mail, in a sealed envelope with first class postage fully prepaid. The envelope was addressed as follows: Law Enforcement Agency:Address:Date of Mailing:Place of Mailing (city and state): 3.I served a copy of the Petition and Order to Seal and Destroy Arrest Records as follows (check one): a.Personal Service: I personally delivered the Petition and Order to Seal and Destroy Arrest Records tothe person at the address listed below:(1)Name of person served:Office of the District Attorney Office of the City Attorney b. Address where served:Date served:Time served: States mail, in a sealed envelope with first class postage fully prepaid. The envelope was addressed as follows: (1)Name of person served:Office of the District Attorney Office of the City Attorney (2)Address: (3)Date of Mailing:(4)Place of Mailing (city and state): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: TYPE OR PRINT NAME SIGNATURE OF DECLARANT American LegalNet, Inc. www.FormsWorkFlow.com