County Court _______________________County, Colorado Court Address: State of Colorado COURT USE ONLY v. Case Number: Defendant: ____________________________________ Division: Courtroom: ORDER TO SEAL PURSUANT TO §18-13-122(10), C.R.S. The Court having read the Petition to Seal Pursuant to §18-13-122(10), C.R.S., and examining the record, finds that the Defendant has not been arrested for, charged with, or convicted of any felony, misdemeanor, or petty offense since the conviction on ______________________ (date), and that the referenced record is eligible for sealing. Information about the Defendant: Date of Birth: __________________________________ Current Mailing Address: ___________________________________________________________ City, State, and Zip Code: __________________________________________________________ The Court orders the following pursuant to §18-13-122(10), C.R.S.: 1. The following information shall be sealed: Date of Offense Name of Law Enforcement Agency Arrest Number 2. The Court directs the Clerk of Court to seal this county court case. 3. The Defendant or his/his attorney shall mail a copy of this Order to the following agencies to seal their records associated with this case: District Attorney Law Enforcement Agency (Identify name of agency): ______________________________________ Department of Motor Vehicle (DMV) Colorado Bureau of Investigation (CBI) State Court Administrator’s Office, 1726 Cole Blvd. Building #22, Suite 300, Golden, CO 80401: Attn: Records Sealed Other: _______________________________________________________________________ Date: ________________________________ ______________________________________ Judge Magistrate I certify that on ___________________________ (date), I mailed this Order to the following: Defendant Defendant’s Attorney JDF 314 R3/07 ORDER TO SEAL PURSUANT TO §18-13-122(10), C.R.S. ___________________________________ Clerk American LegalNet, Inc. www.FormsWorkflow.com