PETITION TO SEAL RECORD(S) under G. L. c. 276, 247 100CTRIAL COURT OF MASSACHUSETTS Q BOSTON MUNICIPAL COURTQ DISTRICT COURTQ SUPERIOR COURTQ JUVENILE COURTDIVISION/COUNTY:Petitioner222s Name: (please print)Petitioner222s Address: (please print)Tel. #PCF # DOCKET NUMBEROFFENSE/CHARGE (Please list each one on a separate line.)DISPOSITIONDATE DISPOSITIONCOURT USE ONLY Q seal Q seal Q seal Q seal Q seal Q seal Q Please see the attached continuation sheet listing additional case(s).I request this Court to order that the record(s) of the criminal charge(s) listed above be sealed, for thefollowing specific reasons: (Please print and attach documents as necessary)DATE:SIGNED UNDER THE PENALTIES OF PERJURYPetitioner222s Signature: ORDER OF COURT QA hearing on the merits of the petition to seal is scheduled on , 20, at AM/PM (no sooner than 7 days). The clerk-magistrate shall ensure that notice of thehearing is given to the probation department and the prosecutor222s office, and shall post a copy of thepetition on a public bulletin board until the scheduled hearing. The prosecutor222s office is advised togive notice to the victim(s), if any, and to inform the victim(s) s/he/they may appear and be heard. QAfter review of the petition and any attachments, and/or a preliminary hearing, the Court finds thatno prima facie case in favor of sealing has been shown, and the petition to seal is DENIED. DATE:JUDGE222S SIGNATURE: American LegalNet, Inc. www.FormsWorkFlow.com PETITION TO SEAL RECORD(S)Continuation SheetTRIAL COURT OF MASSACHUSETTS Q BOSTON MUNICIPAL COURTQ DISTRICT COURTQ SUPERIOR COURTQ JUVENILE COURTDIVISION/COUNTY:Petitioner222s Name: (please print)Petitioner222s Address: (please print)Tel. #PCF # DOCKET NUMBEROFFENSE/CHARGE (Please list each one on a separate line.)DISPOSITIONDATE DISPOSITIONCOURT USE ONLY Q sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ sealQ seal American LegalNet, Inc. www.FormsWorkFlow.com