This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EX - AN 2910.2 Page 1 of 1 ( 0 3 / 1 8 ) STATE OF ILLINOIS, ADDITIONAL NOTICE OF FILING FOR EXPUNGEMENT AND/OR 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 (First, middle, last name) Other names used in these cases If the Clerk gave you a new case number, enter it to the right. Date of birth Race Gender Case Number (if the Clerk Enter the number for all eligible arrests and charges on your criminal record in this county. If an arrest did not result in formal charges, enter the arrest number. assigns a new number) Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County: In 1, enter the additional local police agencies that arrested you. 1. To: Additional Arresting Agencies that arrested you: Name Name Street Address Street Address In 2, enter the names and addresses of the additional Chief Legal Officers of the Units of Local Government that arrested you. The Chief Legal Officer is usually the lawyer for the city or town in which you were arrested. City State ZIP City State ZIP 2. To: Additional Chief Legal Officer s of the Un its of Local Government that arrested y ou: Name Name Street Address Street Address 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. City State ZIP City State ZIP /s/ Your S ignature Date After you finish this form, file it with your Notice. Prepared by: Street Address: City, State, Z IP: Phone Number : American LegalNet, Inc. www.FormsWorkFlow.com