STATE OF MARYLANDvs.DefendantIDARDocument FORM 4-503.3 APPLICATION FOR EXPUNGEMENT OF POLICE RECORD 1.On or about, I was arrested, detained, or confined by an officer of theD.O.B.DateLaw Enforcement AgencyDISTRICT COURT OF MARYLAND FORLocated atCase No.City/CountyCourt AddressDateAddressTelephoneSignature of AttorneyDateAddressTelephoneSignature of Defendant I solemnly affirm under the penalties of perjury that the contents of this application are true to the best of myknowledge, information, and belief and that the arrest to which this application relates was not made for anynonincarcerable violation of the Transportation Article of the State of Maryland. WHEREFORE, I request the Court to enter an Order of Expungement of all police records pertaining to my arrest,detention, or confinement, and all court records of these proceedings. The above named law enforcement agency (check appropriate box) failed to notify me of any action taken within 60 days after receipt of my Notice and Request for Expungement. 4.3.On or about, I requested the law enforcement agency to expunge mypolice record pertaining to the incident.Date2.On or about, I was released without having been charged with a crime.Date.following incident, at, Maryland, as a result of the FORM 4-503.4 NOTICE OF HEARING TO THE LAW ENFORCEMENT AGENCY SERVED HEREWITH: A hearing on the foregoing Application for Expungement of Records has been set foratM. in the District Court forCity/Countyat ,Maryland, at which time an Order for Expungement of Records may be entered. If you wish to oppose the application, within 30 days after the service of this Notice of Hearing you must file andserve upon the applicant or the applicant's attorney of record an answer stating in detail your specific grounds for objection. Issued this day of , To request a foreign language interpreter or a reasonable accommodation under the American with Disabilities Act,please contact the court immediately. Possession and use of cell phones and other electronic devices may be limited orprohibited in designated areas of the court facility.DC-CR-071 (Rev. /201) ClerkMonthYearDatePrinted NamePrinted NameCity, State, ZipCity, State, Zip American LegalNet, Inc. www.FormsWorkFlow.com