Print Form Petition to Seal Conviction Clear Form (Rev. 7/21/08) CCCR 0323 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or ____________________________________________, A Municipal Corporation, v. _______________________________________________ Defendant/Petitioner } Case No(s). ______________________________ ______________________________ ______________________________ ______________________________ PETITION TO SEAL CONVICTION The Defendant/Petitioner petitions the Court to Seal his/her record of conviction and all related records from the records of the Clerk of the Circuit Court, the Department of State Police and the arresting authority(ies) with regard to the following arrest(s): Charge(s): ____________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Date(s) of Arrest(s): _____________________________________________________________________________________________ _____________________________________________________________________________________________________________ Arresting Authority(ies) _________________________________________________________________________________________ _____________________________________________________________________________________________________________ ___________________________________________________________________ I. D. No. ______________________________________ Date of Birth: __________________________ Sex: _____________ Race: __________________________________ Current Address: _________________________________________________________________________________ In support of this Petition, Defendant/Petitioner states as follows: 1. The Defendant/Petitioner was arrested by the arresting authority(ies) on the date(s) and for the offense(s) stated above. 2. The Defendant/Petitioner was convicted on ____________________________, _________. 3. The Defendant/Petitioner completed his/her sentence(s) on ____________________________, _________. 4. The Defendant/Petitioner was NOT convicted of any of the following offenses: 625 ILCS 11-501, et. seq. Driving under the Influence of Alcohol, Other Drug or Drugs, Intoxicating Compound or Compounds or any combination thereof, or a misdemeanor violation of Article 11 of the Criminal Code of 1961, which includes Adultery, Fornication, Public Indecency, Marrying a Bigamist and/or Obscenity, or 720 ILCS 5/26-5 Dog Fighting, or a misdemeanor violation that is a crime of violence as defined in Section 2 of the Crime Victims Compensation Act (740 ILCS 45/2), which includes: 720 ILCS 5/12-1 Assault, or 720 ILCS 5/12-2 Aggravated Assault, or (OVER) (Rev. 7/21/08) CCCR 0323 B 720 ILCS 5/12-3 Battery, or 720 ILCS 5/12-3.2 Domestic Battery, or 720 ILCS 5/12-5 Reckless Conduct, or 720 ILCS 5/12-15 Criminal Sexual Abuse, or 720 ILCS 5/12-30 Violation of an Order of Protection, or 510 ILCS 70/1 a misdemeanor violation of the Humane Care for Animals Act, or 730 ILCS 150/1 any offense or attempted offense that would subject a person to registration under the Sex Offender Registration Act. 5. The Defendant/Petitioner has not subsequently been convicted of any misdemeanor or felony and has not been placed on supervision for a misdemeanor or felony within FOUR (4) years after the completion of his/her sentence. 6. Check if applicable: This Petition is to seal a class 4 felony. The Defendant/Petitioner has not had any prior felony records sealed. 7. Check if applicable: Defendant/Petitioner’s drug test showing the absence of illegal substances is attached. 8. The Defendant/Petitioner has paid all costs and fees for the filing of this Petition. WHEREFORE, the Defendant/Petitioner prays that his/her record of conviction(s) and all related records as maintained by the Clerk of the Circuit Court, the Department of State Police, and the arresting authority(ies) be sealed as allowed by law. ____________________________________ Signature of Defendant/Petitioner VERIFICATION BY CERTIFICATION 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. __________________________________________, _________. Date _______________________________________ Signature of Defendant/Petitioner Received this _______ day of __________________, _________. _______________________________________ State’s Attorney or Prosecutor Atty. No.: ________________ Pro Se 99500 Attorney (or Pro Se Petitioner) Name: ___________________________________________ Address: _________________________________________ City/State/Zip: ____________________________________ Telephone: _______________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS