County Court _________________________ County, Colorado Court Address: State of Colorado v. COURT USE ONLY Defendant: _______________________________________ Attorney or Party Without Attorney (Name and Address): Case Number: Phone Number:____________ E-mail:_________________________ FAX Number:_____________ Atty. Reg. #: ______________ Division ______ Courtroom _______ PETITION TO SEAL PURSUANT TO §18-13-122(10), C.R.S. I, ________________________________________________, (Name of Defendant), petition the court to seal my conviction under §18-13-122(2)(a), C.R.S. (Illegal possession or consumption of ethyl alcohol by an underage person) in the case. 1. Information about the Defendant: Date of Birth: ________________________________ Current Mailing Address: ___________________________________________________________ City, State and Zip Code: __________________________________________________________ Home Phone #: ________________ Work Phone #: _______________ Cell #: ________________ 2. I request that the following information be sealed: Date of Offense Name of Law Enforcement Agency Arrest/Summons Number 3. The conviction was entered by the Court on _____________________ (date) and I have not been arrested for, charged with, or convicted of any felony, misdemeanor, or petty offense during the period of one year following the date of the above conviction. I swear or affirm under oath that I have read the foregoing Petition and that the statements contained in this Petition are true to the best of my knowledge and belief. ____________________________________________ Signature of Defendant Date The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado, this ____day of ___________, 20___, by the Defendant. My Commission Expires: ________________ _____________________________________________ Notary Public/Deputy Clerk ______________________________________ Signature of Attorney Date JDF 313 R11/09 PETITION TO SEAL PURSUANT TO §18-13-122(10), C.R.S. American LegalNet, Inc. www.FormsWorkFlow.com