........................... IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR DADE COUNTY, FLORIDA. : Index No. IN THE COUNTY COURT IN AND FOR DADE COUNTY, FLORIDA. DIVISION CRIMINAL JUVENILE Plaintiff(s) TRAFFIC nst- : Calendar No. 471 CASE NUMBER PETITION TO SEAL : JUDICIAL SUBPOENA : THE STATE OF FLORIDA VS. CLOCK IN : : Defendant(s) 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 943.059, 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 ___________________, OF NEW YORK 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__________________________________________________________________________________________ _________________________________________________________________________________________________. U, that all business and excuses being laid aside, you and each of you attend before 2. The petitioner has not been Court previously adjudicated guilty of any of the charges, stemming from this arrest or alleged criminal at the located at activity. day of , 20 , at noon, and at any recessed 3. The petitioner has not been o'clock in adjudicated guilty of a criminal offense or a comparable ordinance violation. previously the give evidence as petitioner has this securedonpriorpart of the a witness in not action a the records expunction or sealing under section 943.0585, or 943.059, Florida Statutes, 4. The 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. with this subpoena is punishable as afor and been issued a Certificate of Eligibility, Number ______________________, by the Florida contempt of court and will make you liable to 5. The Petitioner has applied ubpoena was issued for a maximum penalty of $50 and all damages sustained as a Department of Law Enforcement. WHEREFORE, the petitioner moves to seal any criminal history record information and any official court records regarding his/her , one of the Justices of the arrest by __________________________________________________ (agency) for __________________________ (charges) day of , 20 on the ________day of ______________, 20____. I HEREBY CERTIFY that a true and correct copy of the foregoing pleading has been served on KATHERINE FERNANDEZ (Attorney 11th Judicial Circuit, in and for RUNDLE, State Attorney for themust sign above and type name below)Dade County, 1350 Northwest 12 Avenue, Miami, FL 33136: _______________________________________________________________ (arresting agency); and the Miami-Dade Police Department, Records Section, 9105 Northwest 25 Street, Miami, FL, 33172, this ________ day of _________________________, 20 _______. Attorney(s) for _______________________________________________ Office and P.O. Address Signature ___________________________________________ Print Name Telephone No.: Address:______________________________ City-State:____________________ Facsimile No.: ( ) E-Mail Address: Telephone Number:______________________ Mobile Tel. No.: Fla. Bar No. :_____________________ CLK/CT 410 Rev .6/02 American LegalNet, Inc. www.USCourtForms.com Clerk's web address: www.miami-dadeclerk.com