District Court _________________________ County, Colorado Court Address: Petition of: ___________________________________________ Defendant (Primary subject of the criminal justice record) Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: _________________ ______________________________________________________ ______________________________________________________ Phone Number:_______________ E-mail:____________________ FAX Number:________________ Atty. Reg. #: _______________ Division ______ Courtroom ______ PETITION TO SEAL ARREST AND CRIMINAL RECORDS PURSUANT TO §24-72-308, C.R.S. 1. The Petitioner is: (check one only) the primary subject of the criminal justice record. the authorized representative of the Defendant (attorney for the Defendant). the parent of the Defendant. the appointed legal representative of the Defendant. 2. Information about the Defendant: Date of Birth: _________________________________ Current Mailing Address: ___________________________________________________________________ City: ________________________________ State: ___________________ Zip Code: _________________ Home Phone #: __________________ Work Phone #: ___________________ Cell #: __________________ 3. The Petitioner asks this Court for an Order to Seal Arrest and Criminal Records information in the custody of the following agencies: District and County Courts Sheriff’s Department District Attorney Law Enforcement Agency (name of agency) ________________________________________________ Municipal Court (location) ______________________________________________________________ Colorado Bureau of Investigation Other ______________________________________________________________________________ 4. The Petitioner further shows the Court that the harm to Petitioner’s privacy, or the danger of unwarranted adverse consequences, outweighs the public interest in retaining the records. Explain: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ (a) The charge(s), if any, in the court case record to be sealed is/are as follows: Indicate in the Dismissal column Yes or No if charges were dismissed due to a plea agreement in a separate case. If Yes, complete section c. * Felony or Misdemeanor JDF 417 R8/08 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Offense Date Arrest Date Arrest Number Charge F/M * Dismissal Deferred Judgment Acquittal No Charges Filed (b) No court case exists (e.g., no charges were filed, only an arrest occurred, no appearance in Court was made); however, the following arrest record(s) exist. If charges were not filed due to a plea agreement in a separate case then Petitioner must not have been charged with any criminal offense in the ten years since the date of the final disposition of all criminal proceedings against the Defendant. Date of Arrest Original Arrest Number Charge (c) A court case exists but was dismissed due to a plea agreement in a separate case and Petitioner is not aware of any charges for any criminal offense in the ten years since the date of the final disposition of all criminal proceedings against the Defendant. Case Number of Case Dismissed Date Case was Dismissed Case Number Identified in the Plea Agreement 5. Court case numbers and criminal justice agency case numbers: County Court case number: ______________________________ District Court case number: ______________________________ Municipal Court Case number: ____________________________ Law Enforcement Agency number: _________________________ Arrest number (from fingerprint card): ______________________ Date: _____________________ Law Enforcement Agency case number: ______________________ Arrest number (from fingerprint card): ________________________ Date: _____________________ 6. The Defendant has paid all restitution, fines, court costs, late fines or other fees ordered by the Court, unless the Court has vacated the Order in the case requesting to be sealed. 7. The Defendant is not the holder of a commercial driver’s license or the operator of a commercial motor vehicle. 8. Petitioner requests the Court to set a date for hearing on this Petition and to enter an order sealing arrest and criminal records pertaining to the Defendant, pursuant to §24-72-308(1)(b)(II), C.R.S. and to seal this action. * Felony or Misdemeanor JDF 417 R8/08 PETITION TO SEAL ARREST AND CRIMINAL RECORDS Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com 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. Date: ____________________________ _____________________________________ Signature of Petitioner or Attorney Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 ______. My Commission Expires: _____________________ * Felony or Misdemeanor JDF 417 R8/08 PETITION TO SEAL ARREST AND CRIMINAL RECORDS ______________________________________ Notary Public /Clerk Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com