1. � In the matter of � � en-USname(s), alias(es) � 2. � On en-USDateen-US , a disposition hearing was held because I was adjudicated, as a juvenile delinquent, of the � � following offense(s): en-US en-US . � A certified record of the adjudication(s) is attached. � � I was not detained for the offense(s). � � � I completed the term of detention for the offense(s) on en-US . � 3. � � No other application has been filed to set aside this/these or any other adjudication(s) in any court. � en-USOR � � One or more applications were filed to set aside adjudications and the applications are pending or were disposed. Copies � of any applications and orders are attached. � 4. � I am 18 years of age or older. 5. � At least one year has passed since the disposition was entered on my adjudication(s) or since I was released from detention � for the adjudication(s). No criminal charges are pending against me. I have not been adjudicated for more offenses than � allowed under MCL 712A.18e(1). I do not have an adult felony conviction. � 6. � I am requesting that multiple adjudications be set aside as one offense. These adjudications arose out of a series of acts � that were in a continuous time sequence of 12 hours or less and displayed a single intent and goal. � 7. � I have completed the Michigan Youth ChalleNGe Academy. My certificate of completion is attached to this application. 8. � I en-USrequesten-US that the court issue an order to set aside the above adjudication(s) as provided by law. I consent to the use of the � nonpublic record created by MCL 712A.18e(13) to the extent authorized by MCL 780.623. en-USApplicant signature � en-USAddress � City, state, zip � Telephone no. � en-USSubscribed and sworn to before me on en-USDateen-US , en-USCountyen-US County, Michigan.en-USMy commission expires: en-USDate � Signature: en-USDeputy clerk/Notary publicen-USNotary public, State of Michigan, County of en-US en-USThe hearing cannot be held until the court receives the Michigan State Police report required under MCL 712A.18e(5).en-USTO: Michigan Attorney General and en-USen-USA hearing will be held on the above application to set aside adjudication(s) on en-USDateen-US at en-USTimeen-USat en-USLocationen-US before en-USBar no.en-US .en-USNOTICE OF HEARING American LegalNet, Inc. www.FormsWorkFlow.com Case No. Petition No. en-USI certify that copies of this application, certified record of adjudication(s), and notice of hearing were served on theen-US � prosecuting official on en-USDateen-US by first-class mail addressed to the last-known address.en-US � Attorney General on en-USDateen-US by first-class mail addressed to the last-known address.en-USI certify that copies of this application, certified record of adjudication(s), and the fingerprint card, accompanied by required fee, � en-USwere served on the Michigan State Police on en-USDateen-US by first-class mail addressed to the last-known address. en-USDate � en-USApplicant signatureen-USINSTRUCTIONS:en-USFor additional instructions and an online interview that will help you create forms, go to michiganlegalhelp.org. 1. � Determine whether you are eligible to apply to have your adjudication set aside according to MCL 712A.18e. You must � complete a separate application for each adjudication if you are applying to have more than one adjudication set aside. 2. � Find out the exact date of adjudication and the charge from the court. Get a certified copy of the adjudication and attach it to � your application. en-US3. Swear to the truth of the statements in this application and then sign it in the presence of the court clerk or a notary public.en-US4. Make four copies of all attachments and this application. Take all copies to the court clerk. 5. � Depending on local practice, the clerk of the court may set a hearing date at the time of filing. If a hearing date is set at the � time of filing, the clerk of the court will complete the Notice of Hearing. 6. � Go to the local law enforcement agency for a fingerprint card and get fingerprinted on the applicant card (RI-8). There may � be a fee for fingerprinting. Fill out the card completely. 7. � Make out a money order or check to the State of Michigan for the application. The application fee is $25.00. This fee is sent � with the application packet to the Michigan State Police for processing. 8. � Mail a copy of the application packet, application fee, and the fingerprint card to the Michigan State Police by first-class mail � to Michigan State Police, Criminal Justice Information Center - Criminal History, PO Box 30266, Lansing, Michigan 48909. 9. � Mail a copy of the application packet to the Attorney General of the State of Michigan by first-class mail to Office of the � Attorney General, Criminal Appellate Division, PO Box 30217, Lansing, Michigan 48909. 10. � Mail a copy of the application packet to the correct prosecuting official where the conviction occurred (county, city, or � township) by first-class mail. See www.michiganprosecutor.org/about-us-menu/prosecutor-directory for the addresses of � county prosecutors. 11. � On both copies of the application, fill in the Proof of Service on the back of the form. After you fill out and sign the Proof of � Service, mail or take one of the remaining application packets with the completed Proof of Service to the court. Keep the � other copy of the application packet for your records. en-USPROOF OF SERVICE American LegalNet, Inc. www.FormsWorkFlow.com