IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT IN AND FOR CLAY COUNTY, FLORIDA. 472 IN THE COUNTY COURT IN AND FOR CLAY COUNTY, FLORIDA. DIVISION CASE NUMBER CRIMINAL PETITION TO EXPUNGE JUVENILE TRAFFIC CLOCK IN THE STATE OF FLORIDA VS. PLAINTIFF DEFENDANT The petitioner, by and through the undersigned attorney, petitions this honorable court, pursuant to Florida Rule of Criminal Procedure 3.692 and section 943.0585, 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 petitioners arrest on the day of , 20 , by (arresting agency), for (charges) , and as grounds therefor shows: 1. On the day of , 20 , the petitioner, , a (race)/ (sex), whose date of birth is , was arrested by and charged with . 2. The petitioner has not been previously adjudicated 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 not secured a prior records expunction or sealing un der section 943.0585, or 943.059, Florida Statutes, former section 943.058, Florida Statutes, former section 893.14, Florid a 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, fo rmer section 943.058, Florida Statutes, former section 893.14, Florida Statutes, or former section 901.33, Florida Statutes , for at least 10 years; or there has not been an indictment or information filed against the petitioner who is the subject of this criminal history information; or an indictment or information filed against the petitioner who is the subject of this criminal history i nformation was dismissed by the prosecutor or the court. 6. The Petitioner has applied for and been issued a Certificate of Eligibi lity, Number , by the Florida Department of Law Enforcement. WHEREFORE, the petitioner moves to expunge any criminal history record i nformation and any official court records regarding his/her arrest by (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 Harry L. Shorstein, State Attorney for the 4th Judicial Circuit, in and for Clay County, 825 North Orange Avenue, Green Cove Springs, FL 32043: (arresting agency); and the Clay County Sheriff Department, Records Section, 901 North Orange Ave.rnG.C.Sp., FL 32043, this day of , 20 . Signature Print Name Address: City-State: Telephone Number:( ) Fla. Bar No. : CLK/CT 24 Rev. 6/02 Clerks web address: http://clayclerk.com/