Event Code: 6154 IN THE CIRCUIT COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA IN THE COUNTY COURT, BREVARD COUNTY, FLORIDA DIVISION CIVIL CRIMINAL JUVENILE TRAFFIC CASE NUMBER 05 - - - - _XXX-XX CLOCK IN AFFIDAVIT FOR SEALING OF CRIMINAL HISTORY RECORD PLAINTIFF STATE OF FLORIDA vs. DEFENDANT/PETITIONER I, _________________________________________, am the Defendant in the above-styled cause and I do hereby sw ear and affirm that: 1. I fully understand the meaning of all the terms of this affidavit. 2. I have never been adjudicated guilty of a criminal offense or a comparable ordinance violation. 3. I w as arrested on the __________ day of _______________________, 20_____, by ______________________________, and I have not been adjudicated guilty of the charges stemming from that arrest or alleged criminal activity surrounding my arrest. 4. I am eligible for the relief requested, to the best of my know ledge and belief, and do not have any other petition to expunge or seal pending before any court. 5. I have never secured a prior records expunction or sealing under any law . Defendant/Petitioner STATE OF FLORIDA, COUNTY OF BREVARD Sw orn to and subscribed before me this _________ day of __________________________________, 20_____. NOTARY PUBLIC, or other person authorized to administer an oath. (Print, type or stamp commissioned name of Notary Public) Personally know n ___________ or produced identification __________. Type of identification produced__________________ . LAW 351 Rev. 05/2007 BAR CODE LABEL American LegalNet, Inc. www.FormsWorkflow.com