This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. SE - AA 2908.2 Page 1 of 1 ( 0 3 / 1 8 ) STATE OF ILLINOIS, ADDITIONAL ARRESTS OR CASES FOR SEALING For Court Use Only CIRCUIT COURT COUNTY Instructions Directly above, enter the name of county where you will file the case. Request of: Enter your name, birth date, race, and gender. List any other names you used when arrested on the cases listed on this form. Your name ( F irst, middle, last) Other names used in these cases Case Number (if the Clerk assigns a If the Clerk gave you a new case number, enter it to the right. new number) Date of birth Race Gender Enter the number for each additional arrest, charge, and conviction you want sealed. If an arrest did not result in formal charges, enter arrest number. Arrest or Case Numbers of A dditional Criminal Offenses in your Record in this County : See How to Expunge and/or Seal a Criminal Record to make sure all of your cases can be hidden by sealing your record. For help filling out this table, see pages 12 226 15. Arrest or Case Number Arresting Agency Charge ( list all charges for each case number ) Date of Arrest Outcome (for example, MC, FC, or CE) Enter all additional eligible arrests, charges, and convictions you want sealed, but could not fit on the Request. Enter all charges for each case number. For Outcome, enter an outcome that reflects the outcome of your case. Use the shortened version of the outcome from the Outcome Abbreviation s box. Outcome Abbreviations MC Misdemeanor Conviction FC Felony Conviction 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. CE Certificate of Eligibility for Sealing from PRB QP Qualified Probation Successfully C ompleted Your Signature Date Prepared by: After you finish this form, file it with your Request. Street City, State, Phone American LegalNet, Inc. www.FormsWorkFlow.com