This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EXJ - AR 3206.1 Page 1 of 2 ( 01 / 1 8 ) STATE OF ILLINOIS, ADDITIONAL JUVENILE RECORDS For Court Use Only CIRCUIT COURT COUNTY Instructions Only complete this form if you have been arrested more than 6 times and asking for all of those arrests to be expunged. If you have been arrested 6 times or less, then you do not need to 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 the county where you will file the case. Enter your name and date of birth. Enter all case numbers listed in this area of the Request form. In 1, fill in the next letter in the space provided starting with g. For each additional eligible offense on your juvenile record, enter: the case number, the police or sheriff's department that arrested you, the charge you were arrested for or the charge you were found guilty of, the date of arrest, and check the box that matches the outcome of your case. If your arrest did not result in a court case, the Circuit Clerk will assign it a case number. When the Circuit Clerk assigns the number enter it here. 1. I ask the c ourt to expunge all my eligible juvenile law enforcement and court records from the agency that arrested me, the Circuit Clerk , a nd the Illinois State Police. I was arrested on the dates and for the offenses listed below: Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion Given supervision and successfully completed it Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion I was given supervision and successfully completed it Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty American LegalNet, Inc. www.FormsWorkFlow.com EXJ - AR 3206.1 Page 2 of 2 ( 0 1 / 1 8 ) See How to Expunge Juvenile Records to make sure all of your cases can be erased by expunging your record. Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion I was given supervision and successfully completed it Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion I was given supervision and successfully completed it Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion I was given supervision and successfully completed it Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest If you do not have enough space to list your cases, you may use an additional page. Outcome for this case (check only one) : Arrest without court case filed/station or probation adjustment/ pre - petition diversion I was given supervision and successfully completed it File this form with your Request to Expunge Juvenile Records form. Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty American LegalNet, Inc. www.FormsWorkFlow.com