Petition for Correction and Sealing of an Arrest and Conviction Record Due to Identity Theft (1/20/16) CCCR N019 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or _________________________________________________ A Municipal Corporation v. ___________________________________________________ Defendant, ___________________________________________________ Petitioner, Case No. ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ 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: _______________________________ Defendant's IR/SID # if any: __________________ Petitioner's IR/SID #, if any: _______________________________ Petitioner's Date of Birth: ______________________ Sex: ________ Race: __________________________________ 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 abovelisted 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.: ___________________ Pro Se 99500 Attorney (or Pro Se Petitioner): Name: _____________________________________________ Address: ____________________________________________ City/State/Zip: _______________________________________ Telephone: __________________________________________ Primary Email: _______________________________________ Secondary Email: _____________________________________ Tertiary Email: ______________________________________ Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements 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 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com