Petition for Correction and Sealing of an Arrest and Conviction Record Due to Identity Theft (3/28/05) CCCR 0019 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or _______________________________________________, A Municipal Corporation, v. _______________________________________________, Defendant, _______________________________________________, Petitioner. } ______________________________ _______________________________ _______________________________ ______________________________ _______________________________ _______________________________ Case Nos. PETITION FOR CORRECTION AND SEALING OF AN ARREST AND CONVICTION RECORD DUE TO IDENTITY THEFT Pursuant to 20 ILCS 2630/5(b), the Petitioner petitions the Court to order the correction and sealing of the arrest and conviction record(s), listed below, bearing the Petitioner’s identity, and in support of the Petition states as follows: 1. Petitioner’s identity was stolen or otherwise came into the possession of the Defendant. 2. Case Number Falsely Containing Petitioner’s Identity: _______________________________________________________ Charge(s) Against Defendant in Above Case: _____________________________________________________________ Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ __________________________ Petitioner’s IR/SID #, if any: ________________________ ________ /________ /________ Sex: ________ Race: _________________________ Defendant’s IR/SID #, if any: Petitioner’s Date of Birth: My identity was stolen or otherwise came into the possession of the Defendant in more than one case. I have provided the above-requested information for each additional case on the attached form. 3. A person other than the Petitioner was convicted of the crime(s) or violation(s) of municipal ordinance(s) under the Petitioner’s identity listed on this form. WHEREFORE, the Petitioner petitions this Court to: A. Order that the arresting authority, the Department of State Police, other criminal justice agencies, the prosecutor, and the Clerk of the Circuit Court remove the name of the Petitioner from all the official records in connection with the above-listed arrest(s) and conviction(s). (Please attach copies of any supporting documents to this Petition.) B. Order that the arresting authority, the Department of State Police, other criminal justice agencies, the prosecutor, and the Clerk of the Circuit Court insert the name of the true offender, if known, of the above crime(s): _____________________________________________, IR/SID # ______________________________, in the place of the Petitioner’s name in all official records in the above case(s). C. Order that the Clerk of the Circuit Court seal the court records relating to the above named cases, and insert the above true offender’s name in the electronic index in the place of the Petitioner’s name. D. The Petitioner prays that the records falsely containing his/her identity be corrected by the Department of State Police, the prosecutor, the arresting authority, and the Clerk of the Circuit Court, and be sealed by the Clerk of the Circuit Court as allowed by law. VERIFICATION BY CERTIFICATION Date: _____________________________________, _________ Atty. No.: _________________ Attorney (or Pro Se Petitioner): Pro Se 99500 _____________________________________________ Address: __________________________________________ City/State/Zip: ______________________________________ Telephone: _________________________________________ Name: Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the state ments set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief, and as to such matters the undersigned certifies as aforesaid that s/he verily believes the same to be true. ______________________________________________ Signature of Petitioner DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form