This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EXJ - AA 3207.1 Page 1 of 1 ( 01 / 1 8 ) STATE OF ILLINOIS, ADDITIONAL ARRESTING AGENCIES For Court Use Only CIRCUIT COURT COUNTY Instructions Use this form only if you have been arrested by more than 2 police or sheriff222s department. If you have been arrested by only 2 police or sheriff222s departments, do not complete this form. Request of: Your name ( F irst, middle, last name ) Date of birth Case n umbers for all of your juvenile court records in this County : Directly above, enter the name of county where you will file the case. Enter yo ur name and birth date . Enter all case numbers listed in this area of the Request form. In 1, enter the names and addresses of the additional police or sheriff's department that arrested you. 1. To: Additional Police or Sheriff222s Department that arrested you: Name Name Street Address Street Address City State ZIP City State ZIP If you are completing this form on a computer, sign your name by typing it. If you are completing it by hand, sign and print your name. Then file it with the Notice of Filing for Juvenile Expungement. Name Name Street Address Street Address City State ZIP City State ZIP /s/ Your Signature Date Enter your name, address, and phone number. Prepared by: Street Address: City, State, ZIP: Phone Number : American LegalNet, Inc. www.FormsWorkFlow.com