This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. Page 1 of 2 STATE OF ILLINOIS, ORDER TO EXPUNGE & IMPOUND AND/OR SEAL CRIMINAL RECORDS For Court Use Only CIRCUIT COURT COUNTY Instructions above the name where you will file th 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): In 1, enter the number for all cases listed under Number 2 on the Request form for the cases you want to have expunged. If you completed an Additional Arrests or Cases for Expungement form, fill out an additional Order and list those cases. 1. Arrest or Case Numbers of all Eligible Criminal Offenses for Expungement in this County: I have attached an additional Order form. In 2, enter the number for all cases listed under Number 14 on the Request form for the cases you want to have sealed. If you completed an Additional Arrests or Cases for Sealing form, fill out an additional Order and list those cases. 2. Arrest or Case Numbers of all Eligible Criminal Offenses for Sealing in this County: I have attached an additional Order form. (Continued on next page) IT IS ORDERED: DO NOT check this box. The judge will check the correct boxes. Your R equest for expungement is GRANTED for the above cases and within 60 days of this O rder : The Arresting Agencies must expunge these records as required by law. The judge will cross out the case numbers that are denied and include them on the Order Denying Request To Expunge & Impound and/or Seal Criminal Records. The Clerk of the Circuit Court must impound these records as required by law. The Illinois State Police must expunge or impound these records as required by law. The Illinois State Police and the Arresting Agencies must request the return of all arrest or conviction records from any agencies that were previously notified of these records as required by law. The Illinois State Police must expunge any pardoned conviction and other arrests by sealing these records as required by law. American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: EX - O 2905.3 Page 2 of 2 ( 09 / 18 ) IT IS ORDERED: DO NOT check this box. The judge will check the correct box. Your R equest for sealing is GRANTED for the above cases and within 60 days of receiving this O rder : The Illinois State Police, the Arresting Agencies, and the Clerk of the Circuit Court must seal these records as required by law. The Illinois State Police and the Arresting Agencies must request the return of all arrest or conviction records from any agencies that were previously notified of these records as required by law. Enter the name and contact information of the person completing the Order. Prepared by: Street Address: Phone Number: City, State, ZIP: Email Address: DO NOT fill in these lines. The judge will sign and enter date here. ENTERED: Judge : Date: American LegalNet, Inc. www.FormsWorkFlow.com