IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA. 472 DIVISION CRIMINAL JUVENILE TRAFFIC/MISDEMEANOR PETITION TO EXPUNGE CASE NUMBER THE STATE OF FLORIDA VS. PLAINTIFF DEFENDANT CLOCK IN 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 petitioner's arrest on the day of, 20, by (arresting agency), for (charges) , and as grounds therefore 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 under section 943.0585, or 943.059, Florida Statutes, former section943.058, Florida Statutes, former section 893.14, Florida Statutes, or former section 901.33, Florida Statutes, or any other law, rule orauthority.5.Such record has been sealed under section 943.059, Florida Statutes, former 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 informationfiled against the petitioner who is the subject of this criminal history information; or an indictment or information filed against the petitionerwho is the subject of this criminal history information was dismissed by the prosecutor or the court.6.The Petitioner has applied for and been issued a Certificate of Eligibility, Number , by the Florida Department of Law Enforcement. WHEREFORE, the petitioner moves to expunge any criminal history record information 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 KATHERINE FERNANDEZ RUNDLE, State Attorney for the 11th Judicial Circuit, in and for Miami-Dade County, 1350 Northwest 12th Avenue, Miami, FL 33136: (arresting agency); and the Miami-Dade Police Department, Records Section, 9105 Northwest 25th Street, Miami, FL, 33172, this day of , 20. Signature Print Name Address: City-State Zip Code: Telephone Number: () Fla. Bar No: CLK/CT 24 Rev. 11/17 Clerk222s web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com