IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT IN AND FOR CLAY COUNTY, FLORIDA. 471 IN THE COUNTY COURT IN AND FOR CLAY COUNTY, FLORIDA. DIVISION CRIMINAL CASE NUMBER PETITION TO SEAL JUVENILE TRAFFIC THE STATE OF FLORIDA VS. CLOCK IN PLAINTIFF DEFENDANT The petitioner, by and through the undersigned attorney, petitions this honorable court, pursuant to Florida Rule of Criminal Proce-dure 3.692 and section 943.059, Florida Statutes, to seal all criminal h istory record information in the custody of any criminaljustice agency and the official records of the court concerning the peti tioners 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, Florida Statutes, or former section 901.33, Florida Statutes, or any other law, rule or authority. 5 . 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 seal any criminal history record info rmation and any official court records regarding his/herarrest 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 Ave., Green Cove Springs, FL 32043: arresting agency); and the (Clay County SheriffDepartment, 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 410 Rev.6/02 Clerks web address: http://clayclerk.com/