IN THE COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA DIVISION: CASE NUMBER 05 - - - - XXX-XX PLAINTIFF STATE OF FLORIDA vs. CLOCK IN DEFENDANT/PETITIONER MOTION TO SEAL CRIMINAL HISTORY RECORD 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 seal 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 guilty of a criminal offense or a comparable ordinance violation. 4. The petitioner has never secured a prior sealing or expunction of a criminal history record under Section 943.0585, or 943.059, Florida Statutes, former s 943.058, former s 893.14, or former s 901.33, Florida Statutes, or any other law , rule, or authority. WHEREFORE, the petitioner, ____________________________________, moves to seal 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 Eighteenth Judicial Circuit, in and for Brevard County, Florida; _________________________________________________ (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: LAW 352 Rev. 04-24-2013 FL BAR NUMBER: BAR CODE LABEL American LegalNet, Inc. www.FormsWorkFlow.com