Petition to Seal Criminal Records (01/20/17) CCCR N333 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or ____________________________________________________________ A Municipal Corporation, v. ____________________________________________________________ Defendant/Petitioner Case Nos. __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ Date of Birth: _______________ Gender: Male Female Race: _____________________ PETITION TO SEAL CRIMINAL RECORDS - FEE REQUIRED The above named Petitioner states under oath that: 1. The Petitioner was arrested and/or charged on the date(s) and for the offense(s) stated below: Case Number(s) Arresting Agency(ies) Charge(s) Date(s) of Arrest SID/IR/DCN/CB Disposition Additional cases listed on attached page Petitioner's Address:_____________________________________________________________________________ _____________________________________________________________________________________________ 2. he Petitioner's arrest(s) or charge(s) not initiated by arrest was not a felony offense, unless the felony charge was T amended to a misdemeanor or otherwise eligible to be sealed. 3. he Petitioner's arrest(s) or charge(s) not initiated by arrest resulted in order(s) of supervision or convictions that T are subject to sealing and s/he earned a high school diploma, associate's degree, career certificate, vocational technical certification, bachelor's degree, or passed the school level Test of General Educational Development during the requisite time period. 4. he Petitioner's arrest(s) or charge(s) not initiated by arrest resulted in order(s) of supervision for an offense that T is subject to sealing, successfully completed by the petitioner, and the requisite time period has elapsed. 5. he Petitioner's arrest(s) or charge(s) not initiated by arrest resulted in misdemeanor conviction(s) for an offense T that is subject to sealing, and the requisite time period has elapsed. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 Petition to Seal Criminal Records (01/20/17) CCCR N333 B 6. The Petitioner's arrest(s) or charge(s) not initiated by arrest resulted in order(s) of first offender probation for an offense that is subject to sealing, the requisite time period has elapsed, and the Petitioner has attached a drug test. 7. The Petitioner's arrest(s) or charge(s) not initiated by arrest resulted in a felony conviction for an offense that is subject to sealing, the requisite time period has elapsed, and (for drug cases and cases authorized to be sealed by the Illinois Prisoner Review Board) the Petitioner has attached a drug test. 8. The Petitioner has not previously had any felony conviction sealed or the Petitioner has not been convicted of any felony offense after the date of an order granting the sealing of a felony conviction. 9. The Petitioner does not have any pending charges against him/her. 10. The Petitioner has received a certificate of eligibility for sealing from the Prisoner Review Board. The relief should be granted for the following reasons: _________________________________________________________________________________________________ _________________________________________________________________________________________________ W , the Petitioner asks the Court to seal his/her arrest records. Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, 735 ILCS 5/1-109, 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. Dated: _________________________________ ________________________________________ Defendant/Petitioner Prepared by: _________________________________________ Cook County Attorney Code: ____________________________ Address: _____________________________________________ City/State/Zip: ________________________________________ Telephone: ___________________________________________ Primary Email: _______________________________________ Secondary Email: ______________________________________ Tertiary Email: ________________________________________ Received this day ________of _______________ _______________________________________ (State's Attorney/Prosecutor/ISP/Arresting Agency/ Chief Local Government Legal Office) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2