This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EXJ - R 3203.1 Page 1 of 3 ( 0 1 / 18 ) STATE OF ILLINOIS, REQUEST TO EXPUNGE JUVENILE RECORDS For Court Use Only CIRCUIT COURT COUNTY Instructions Directly above, enter the name of county where you will file the case. Request of: En ter your name and date of birth . Your name ( F irst, middle, last name ) Enter the number for court cases in your juvenile record that you are asking to expunge. If an 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. Date of birth Case n umbers for all of your juvenile court records in this County : In 1, for each 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: a. 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 or not delinquent b. 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 or not delinquent See How to Expunge Juvenile Records to make sure all of your cases can be erased by expunging your record. c. Case Number Arresting Agency Arrest Charge s (if you were found guilty of a different charge, list that charge) Date of Arrest American LegalNet, Inc. www.FormsWorkFlow.com EXJ - R 3203.1 Page 2 of 3 ( 0 1 / 1 8 ) 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 or not delinquent d. 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 or not delinquent e. 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 or not delinquent f. 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 If all of your eligible offenses will not fit on this page, list the rest on one or more Additional Juvenile Records forms and file it with this Request. Guilty of felony or class A misdemeanor Case dismissed (thrown out) Guilty of class B or C misdemeanor Found not guilty or not delinquent I have listed additional eligible juvenile arrests, charges, or guilty findings on the Additional Juvenile Records form which I will file with this Request . In 2 , enter your current address. This is the address where the court or law enforcement agency will send you documents. 2. My mailing address is: Street , Apt # City State Z IP If I move or change my email address I will file a Change of Address form . American LegalNet, Inc. www.FormsWorkFlow.com EXJ - R 3203.1 Page 3 of 3 ( 0 1 / 1 8 ) In order to fill out Subsection 1 and 2 , see the How to Expunge Juvenile Records. ***Fill out subsection 1 or subsection 2 or both depending on your juvenile record*** 3. SUBSECTION 1 All juvenile court proceedings related to the arrests and cases I am seeking to expunge are In 3, check Subsection 1 if the statement applies to you. closed. In 4, check Subsection 2 if a and b apply to you. 4. SUBSECTION 2 a. At least 2 years have passed since all my juvenile cases ended. This includes juvenile probation, serving time in the Department of Juvenile Justice, and parole (IDJJ Aftercare). In 4a, enter the date your last juvenile case ended. The date my last juvenile case sentence ended was: Date b. None of the cases I am trying to expunge are cases where I was found guilty of first degree murder or an offense that requires me to register under the Sex Offender Registration Act. Under the Code of Civil Procedure, 735 ILCS 5/1-109 , making a statement on this form that you know to be false is perjury, a Class 3 Felony. I certify that everything in the Request to Expunge Juvenile Records is true and correct. I understand that making a false statement on this form is perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . /s/ Your signature Date 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. Prepared by: For official use only Street Address: State222s Attorney/Prosecutor/ISP/Arresting City, State, Z IP: Agency/Chief Local Legal Officer : DO NOT fill in the box to the right. Phone Number : Received on: GETTING COURT DOCUMENTS BY EMAIL: If you agree to receive court documents by email, check the box below and enter your email address. You should use an email account that you do not share with anyone else and that you check every day. If you do not check your email every day, you may miss important information or notice of court dates. Other parties may still send you court documents by mail. I agree to receive court documents at this email address during my entire case. 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