Print Form Clear Form This form is to be used in cases involving a sentence of supervision for charges of: 625 ILCS 5/3-707 formerly Ch. 95½ 3-707 - UNINSURED MOTOR VEHICLE 625 ILCS 5/3-708 formerly Ch. 95½ 3-708 - SUSPENDED REGISTRATION FOR NON-INSURANCE 625 ILCS 5/3-710 formerly Ch. 95½ 3-710 - DISPLAY OF FALSE INSURANCE 625 ILCS 5/5-401.3 formerly Ch. 95½ 5-401.3(b) - SCRAP PROCESSOR TO KEEP RECORDS 625 ILCS 5/11-503 formerly Ch. 95½ 11-503 - RECKLESS DRIVING 720 ILCS 5/12-3.2 formerly Ch. 38 12-3.2 - DOMESTIC BATTERY 720 ILCS 5/12-15 formerly Ch. 38 12-15 - CRIMINAL SEXUAL ABUSE 720 ILCS 5/12-4.3 formerly Ch. 38 12-4.3(a) & (b) - AGGRAVATED BATTERY OF A CHILD 720 ILCS 5/16 A-3 formerly Ch. 38 16A-3- OFFENSE OF RETAIL THEFT 720 ILCS 550/10 formerly Ch. 56½ 710 - CANNABIS CONTROL ACT/First Time Offender 720 ILCS 570/410 formerly Ch. 56½ 1410 - CONTROLLED SUBSTANCE ACT/First Time Offender 720 ILCS 570/312 (j) formerly Ch. 56½ 1312 - STEROID CONTROL ACT 20 ILCS 305/10-102 or 301/40-10 formerly Ch. 111½ 6360-2 - ALCOHOL AND DRUG DEPENDENCY ACT (Rev. 7/15/08) CCCR 0012 (This form replaces CCG 0056A) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS THE PEOPLE OF THE STATE OF ILLINOIS or A MUNICIPAL CORPORATION v. } ______________________________ ______________________________ ______________________________ _____________________________________________________ ______________________________ Defendant/Petitioner Charge(s): ______________________________________________________________________________________________________ ______________________________ Case No(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 AND SEAL The above named Defendant/Petitioner states under oath, that: 1. The Petitioner was arrested by the Arresting Authority(ies) on the date(s) and for the offense(s) stated above. 2. The Petitioner was released without being convicted following a sentence of probation or supervision and it has been five (5) years since discharge and dismissal of that probation or 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: ____________________________________, ________ ___________________________________________________ Prepared by: ________________________________________ Defendant/Petitioner Atty. No.: _________________ Received this ______ day of ___________________, _________ Address: __________________________________________ City/State/Zip: _____________________________________ ____________________________________________________ Telephone: _______________________________________ State's Attorney or Prosecutor DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS