Page 1 of 2 Event Code: 6151 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 MOTION TO EXPUNGE CRIMINAL HISTORY RECORD PLAINTIFF STATE OF FLORIDA vs. DEFENDANT/PETITIONER The petitioner, __________________________________________, by and through the undersigned attorney, petitions this honorable court, pursuant to Florida Rules of Criminal Procedure 3.692, and section 943.0585 or section 943.59 Florida Statutes, to expunge all criminal history record information in the custody of any criminal justice agency and the official records of the court, concerning the petitioner' s arrest on the ________ day of __________________________, 20_____, by________________________________________________(arresting agency), and charged w ith________________________________________________________________________________________________ (charges), and as grounds therefore show s: 1. On the _________ day of ____________________, 20____, the petitioner,____________________________, a _____________(race/sex), w hose date of birth is _________________________(date of birth), w as arrested by __________________________________(arresting agency), and charged w ith________________________________ _____________________________________________________________________________________________(charges). 2. The petitioner has not been adjudicted guilty of any of the charges stemming from this arrest or alleged criminal activity. 3. The petitioner has not been previously adjudicated guilt y of a criminal offense or a comparable ordinance violation. 4. The petitioner has not secured a prior records expunction or sealing under Section 943.0585, or 943.059, Florida Statutes, former section 943.058, Florida Statutes, former section 893.14, Florida Statutes, or former section 901.33, Florida Statutes, or any other law , rule, or authority. 5. Such record has been sealed under section 943.059, Florida Statutes, former section 943.058, Florida Statutes, former section 893.14, Florida Statute, or former section 901.33, Florida Statutes, for at least (10) years; or there has not been an indictment or inf ormation filed against the petitioner w ho is the subject of this criminal history record information; or an indictment or information filed against the petitioner w ho is the subject of this criminal history information w as dismissed by the prosecutor or the court. LAW 349 Rev. 03/2007 BAR CODE LABEL American LegalNet, Inc. www.FormsWorkflow.com Page 2 of 2 DEFENDANT MOTION TO EXPUNGE CRIMINAL HISTORY RECORD CASE NUMBER 05 - - - - _XXX-XX WHEREFORE, the petitioner, ____________________________________________, moves to expunge any criminal history record information and any official court records regarding his/her arrest by ______________________________ _____________________ (arresting agency), for __________________________________________________________________ ___________________________________________ (charges), on the _________day of _______________________, 20 _____. I HEREBY CERTIFY that a true and correct copy of the foregoing pleading has been served on_____________ ____________________________(name of prosecuting authority), State Attorney for the _____________ Judicial Circuit, in and for ____________________ County; _____________________________________________________ (arresting agency); ________________________________________________ (Sheriff of county w here defendant w as arrested, if different); this _______ day of _____________________, 20 ________. SIGNATURE Name: Address: City/State/Zip: Telephone Number: FL Bar No: LAW 349 Rev. 03/2007 American LegalNet, Inc. www.FormsWorkflow.com