ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name, State Bar number, and address): TELEPHONE NO: FAX NO. (Optional) EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CRUZ 701 Ocean Street, Room 120 Santa Cruz, CA 95060 THE PEOPLE OF THE ST ATE OF CALIFORNIA: vs. DEFENDANT : PETITION TO SEAL AND DESTROY ARREST RECORDS Penal Code 247247 851.8 (FACTUAL INNOCENCE) CASE NUMBER: HEARING DATE: TIME: DEPT: Form Adopted for OPTIONAL USE Superior Court of Santa Cruz County SUPCR 1125 Rev 0 1 /1/1 9 PETITION TO SEAL ARREST RECORDS Page 1 of 3 Penal Code 247 247851.8 SUP CR 1125 Petitioner requests the Court order the sealing and destruction of the record of arrest under Penal Code 247851.8 (Factual Innocence) 1. Fill in the information relating to the arrest. Do not leave blank boxes. If the information is unknown, please indicate in the appropriate box. Last First Middle Name: Date of Birth: Date of Arrest: Arresting Agency: Booking No: Charges: Disposition: 2. No complaint was filed. Petitioner has previously petitioned the arresting agency by filing the Department of Justice form BCIA 8270: A. The petition was denied on: . A copy is attached. B. It has been over 60 days and I have not received a response to my petition dated: . A copy is attached. i. The copy is stamped received by both agencies to show date of delivery. ii. A completed Proof of Service is attached. 3. A complaint was filed on . The case was dismissed on 4. Petitioner requests relief from the two - year time restriction (Penal Code 851.8(I)) because: American LegalNet, Inc. www.FormsWorkFlow.com Form Adopted for OPTIONAL USE Superior Court of Santa Cruz County SUPCR 1125 Rev 0 1 /1/1 9 PETITION TO SEAL ARREST RECORDS Page 2 of 3 Penal Code 247 247851.8 PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: CASE NUMBER: 5. No reasonable cause exists to believe that the Petitioner committed the offense for which the arrest was made. A statement of facts is below on attachment, and supporting documentation attached showing factual innocence. (Attach additiona l pages as necessary) I declare under penalty of pe rjury under the laws of the State of California that the foregoing is true and correct. Date: Print Name of Petitioner or Attorney for Petitioner Signature American LegalNet, Inc. www.FormsWorkFlow.com Form Adopted for OPTIONAL USE Superior Court of Santa Cruz County SUPCR 1125 Rev 0 1 /1/1 9 PETITION TO SEAL ARREST RECORDS Page 3 of 3 Penal Code 247 247851.8 PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: CASE 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 to Seal and Destroy Arrest Records and the Order Sealing and Destroying Arrest Records as follows (check one): a. Personal Service: On (date) at (time) I personally delivered a copy of the Petition to Seal and Destroy Arrest Records and the Order Sealing and Destroying Arrest Records to the Office of the District Attorney, 70 1 Ocean Street Room 200, Santa Cruz, CA 95060. b. Service by Mail: On (date) at (city, state) I deposited a copy of the Petition to Seal and Destroy Arrest Records and the Order Seal ing and Destroying Arrest Records in the United States mail in a sealed envelope with first class postage fully prepaid addressed to the Office of the District Attorney, 701 Ocean Street Room 200, Santa Cruz, CA 95060. 3. I served a copy of the Petition to Seal and Destroy Arrest Records and the Order Sealing and Destroying Arrest Records as follows (check one): a. Personal Service: On (date) at (time) I personally delivered a copy of the Petition to Seal and Destroy Ar rest Records and the Order Sealing and Destroying Arrest Records to: (1) Law Enforcement Agency: (2) Address where served: b. Service by Mail: On (date) at (city, state) I deposited a cop y of the Petition to Seal and Destroy Arrest Records and the Order Sealing and Destroying Arrest Records in the United States mail in a sealed envelope with first class postage fully prepaid. The envelope was addressed as follows: (1) Law Enforcement Agency: (2) A ddress where mailed: 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