This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EX - N 2904.2 Page 1 of 2 ( 0 3 / 1 8 ) STATE OF ILLINOIS, 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 assigns a new number) 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. Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County: In 1, enter the State222s Attorney office that prosecuted your cases. 1. To: County State222s Attorney County Name In 2, enter the local police agencies that arrested you. If you run out of space, use the Additional Notice of Filing for Expungement and/or Sealing form and check the box. Street Address City State ZIP 2. To: Arresting Agencies that arrested you: Name Name Street Address Street Address In 3, enter the names and addresses of the Chief Legal Officer of the Unit of Local Government that arrested you. The Chief Legal Officer is usually the lawyer for the city or town in which you were arrested or, in some cases, if you were arrested by the sheriff, it is the State's Attorney for that county. If you run out of space, use the Additional Notice of Filing for Expungement and/or Sealing form and check the box. City State ZIP City State ZIP I have listed additional Arresting Agencies on the attached Additional Notice of Filing for Expungement and/ or Sealing form. 3. To: Chief Legal Officer s of the Un its of Local Government that arrested you : Name Name Street Address Street Address City State ZIP City State ZIP I have listed additional Chief Legal Officer s on the attached Additional Notice of Filing for Expungement and/ or Sealing form . 4. To: Illinois State Police 260 North Chicago Street Joliet, Illinois 60432 American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: EX - N 2904.2 Page 2 of 2 ( 0 3 / 1 8 ) In 5, enter the name of the county where you are filing your Request. 5. I have filed a Request to Expunge & Impound and/or Seal Criminal Records with the Clerk of the Circuit Court of County, Illinois . County Name In 6, check the box if you have or are getting a fee waiver. 6. I am seeking a fee waiver under Supreme Court Rule 298, or have attached an Order waiving my filing and State Police fees. 7 . The Circuit Court Clerk will mail a copy of this Notice and the Request to all of the agencies listed above in sections 1 - 4. 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. /s/ Your Signature Date Prepared by: Street Address: City, State, Z IP: Phone Number : CERTIFICATE OF MAILING DO NOT fill out this section. The Circuit Clerk will sign and mail it. The unders igned certifies that the above Notice and attached documents were placed in the U.S. Mail with first class postage prepaid to all parties listed above. Signature of Circuit Clerk Name of Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com