This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EXJ - N 3204.1 Page 1 of 2 ( 01 / 18 ) STATE OF ILLINOIS, NOTICE OF FILING FOR JUVENILE EXPUNGEMENT For Court Use Only CIRCUIT COURT COUNTY Instructions Directly above, enter the name of county where you will file the case. Request of: Your name ( F irst, middle, last name ) Enter your name and birth date. Date of birth Enter all case numbers you listed in this area of your Request form. Case numbers for all of your juvenile court records in this County : In 1, enter the State222s Attorney222s Office in the County where you are filing. 1. To: County State222s Attorney222s Office County Name Street Address City State ZIP In 2, enter the police or sheriff's department that arrested you. If there are more than 2, use the Additional Arresting Agencies form and check the box and file it with this Notice. 2. To: Police or Sheriff222s Department that arrested you: Name Name Street Address Street Address City State ZIP City State ZIP I have listed additional Arresting Agencies on the Additional Arresting Agencies form which I will file with this Notice . 3. To: Illinois State Police 260 North Chicago Street Joliet, Illinois 60432 4. I have filed a Request to Expunge Juvenile Records with the Circuit Clerk of County, Illinois . County Name 5. The Circuit Clerk will mail a copy of this Notice and the Request to all of the agencies listed above in sections 1 - 3. American LegalNet, Inc. www.FormsWorkFlow.com EXJ - N 3204.1 Page 2 of 2 ( 01 / 18 ) 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: Enter your name, address, and phone number. 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