Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Petition to Expunge Form. This is a Illinois form and can be use in Cook Local County.
Loading PDF...
Tags: Petition to Expunge, CCCR 0011, Illinois Local County, Cook
Print Form
Clear Form
THIS FORM IS TO BE USED FOR CASES INVOLVING ACQUITTAL, RELEASE WITHOUT CONVICTION OR FOR
CASES INVOLVING A SENTENCE OF SUPERVISION FOR CHARGES NOT SPECIFIED IN 20 ILCS 2630/5(a)
(Rev. 7/15/08) CCCR 0011
(This form replaces CCG 0056)
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
THE PEOPLE OF THE STATE OF ILLINOIS
or
A MUNICIPAL CORPORATION
v.
____________________________________________________
Defendant/Petitioner
}
Case No(s).
______________________________
______________________________
______________________________
______________________________
______________________________
Charge(s): _____________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Date(s) of Arrest(s): _____________________________________________________________________________________________
_____________________________________________________________________________________________________________
Arresting Authority(ies) __________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________ I. D. No. _____________________________________
(ISB, IR, FBI, DCN)
Date of Birth: _____________________________ Sex: _________________
Race: ______________________________________
Return Records to Petitioner at:
Address: ___________________________________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________________________________
PETITION TO EXPUNGE
The above named Defendant/Petitioner states under oath, that:
1.
2.
The Petitioner was arrested by the Arresting Authority(ies) on the date(s) and for the offense(s) stated above.
(a) The Petitioner was released without being convicted or,
(b) The Petitioner was released without being convicted following a sentence of supervision and it has been two (2) years since
discharge and dismissal of that supervision.
3.
The Petitioner has not previously nor has s/he subsequently been convicted of any criminal offense or any municipal ordinance
violation, including violations of 625 ILCS 5/4-400 and 5/11-204.1, formerly Chapter 4, and Section 11-204.1 of the Illinois Vehicle
Code, and s/he has not since been arrested for any such offense and there are no criminal charges pending against him/her at the
present
time.
4.
Under penalties provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned Petitioner 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 Petitioner certifies as aforesaid that s/he believes the same to be true.
WHEREFORE, the Petitioner asks the Court to expunge his/her arrest records and return the same to Petitioner at the address
shown above.
Dated: ____________________________________, ________ ___________________________________________________
Defendant/Petitioner
Prepared by:
___________________________________
Atty. No.:
_________________
Address: _______________________________________
Received this _______ day of ___________________, ________
City/State/Zip: ___________________________________
____________________________________________________
Telephone:
_____________________________________
State's Attorney or Prosecutor
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS