County Court _______________________County, Colorado Court Address: State of Colorado COURT USE ONLY Case Number: v. 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: 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/Summons 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, 101 W. Colfax Ave., Suite 500, Denver, CO 80202-5351: 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 R11/09 ORDER TO SEAL PURSUANT TO §18-13-122(10), C.R.S. ___________________________________ Clerk American LegalNet, Inc. www.FormsWorkFlow.com