J DF 417 R 8 /19 PETITION TO SEAL ARREST AND CRIMINAL RECORDS WHEN NOT CHARGES FILED PURSUANT TO 24724 - 72 - 704, C.R.S. Page 1 of 3 District Court County, Colorado Court Address: Petition of: Person in Interest (Primary subject of the criminal justice record) COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION TO SEAL ARREST AND CRIMINAL RECORDS WHEN NO CHARGES FILED PURSUANT TO 24724 - 72 - 70 4 , C.R.S. 1. The Petitioner is: (check one only) the P erson in I nterest that is the primary subject of the criminal justice record. the designated representative of the P erson in I nterest , by power of attorney or notarized authorization . the parent of the P erson in I nterest , if the P erson in I nterest is under legal disability . the appointed legal representative of the P erson in I nterest , if P erson in I nterest is under legal disability . 2. Information about the Person in Interest : 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 Attorney Law Enforcement Agency (name of agency) Municipal Court (location) Colorado Bureau of Investigation Other 4. COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW IF CHARGES WERE FILED OR IF NO CHARGES WERE FILED BUT THE PERSON IN INTEREST SUCCESSFULLY COMPLETED A DIVERSION AGREEMENT PURSUANT TO 247 18 - 1.3 - 101, C.R.S. i. Complete the first five columns of the table below for all records the Person in Interest is asking the Court to seal. ii. Deferred: If the charge w as dismissed as a result of completion of a deferred judgment and sentence , indicate Yes in the Deferred Judgment column . Offense Date Arrest Date Arrest or Summons Number F/M * Deferred Judgment * F/M asks Petitioner to state if P erson in I Felony (F) or Misdemeanor (M) charges. American LegalNet, Inc. www.FormsWorkFlow.com J DF 417 R 8 /19 PETITION TO SEAL ARREST AND CRIMINAL RECORDS WHEN NOT CHARGES FILED PURSUANT TO 24724 - 72 - 704, C.R.S. Page 2 of 3 5 . COMPLETE THIS SECTION, INCLUDING THE TABLE BELOW, IF ARREST RECORDS EXIST, NO CHARGES WERE FILED, AND THE PERSON IN INTEREST DID NOT SUCCESSFULLY COMPLETE A DIVERSION AGREEMENT PURSUANT TO 247 18 - 1.3.101, C.R.S. i. The Person in Interest may only ask the Court to seal the arrest records if and the statute of limitati ons fo r the offense for which the person was arrested that has the longest statute of limitations has run OR the statute of limitations has not run , but the Person in Interest is no longer being investigate d by law enforcement for the commission of the offense . Date of Arrest Original Arrest Number Offense 6 . C riminal justice agency case numbers: Law Enforcement Agency case number: Arrest number (from fingerprint card): Date: 7 . 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 Person in Interest , pursuant to 247 24 - 72 - 70 4 (1)( c )(II), C.R.S. By checking this box, I am acknowledging I am fillin g in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE (Printed name of Petitioner) Signature of Petitioner Date Signature of Attorney Date American LegalNet, Inc. www.FormsWorkFlow.com