Petition to Expunge and Impound Criminal Records - No Fee (01/2/1) CCCR 0338 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISPEOPLE OF THE STATE OF ILLINOISor A Municipal Corporationv. Defendant/PetitionerNo. Date of Birth: Gender: Male FemaleRace: DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOISPage 1 of 2 PETITION TO EXPUNGE AND IMPOUND CRIMINAL RECORDS - NO FEE REQUIRED UNTIL 1/1/201Th e above-named Petitioner states under oath that:1. Th e Petitioner was arrested and/or charged on the date(s) and for the off ense(s) stated below: Case Number(s)Arresting Agency(ies)Charge(s)Date(s) of ArrestSID/IR/DCN/CBDispositionAdditional cases listed on attached page.Petitioner220s Address: 2. 002 e Petitioner220s conviction was set aside on direct review or on collateral attack and the court determined byclear and convincing evidence that the Petitioner was factually innocent of the charge.3. Each arrest or charge not initiated by arrest, other than a minor tra004 c o003 ense resulted ina. acquittal, dismissal, or the petitioner220s release without charging; and/orb. a conviction that was vacated or reversed.4. 002 e Petitioner was arrested and released without charging for a minor tra004 c o003 ense.5. 002 e Petitioner does not have pending charges against him/her.DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOISPage 2 of 2 (01/2/1) CCCR 0338 B Petition to Expunge and Impound Criminal Records - No Fee002 e relief should be granted for the following reason(s):WHEREFORE, the Petitioner asks the Court to expunge and impound his/her arrest records and return the expunged records to Petitioner at the address shown above (or at the address updated by the Petitioner with the Clerk of Court as required by 20 ILCS 2630/5.2(d)(2). Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, 735 ILCS 5/1-109, the undersigned certi005 es 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 certi005 es as aforesaid that s/he verily believes the same to be true. Prepared by: Cook County Attorney Code: Address: City/State/Zip: Telephone: Primary Email: Secondary Email: Tertiary Email: Defendant/PetitionerDated: Received this day of (State220s Attorney/Prosecutor/ISP/Arresting Agency/Chief Local Government Legal O004 ce)