IN THE ______ JUDICIAL CIRCUIT COURT, __________________________, MISSOURI Judge or Division: Petitioner: vs. (Date File Stamp) Case Number: Court ORI No.: Defendant(s): Circuit Court Division _____________ Associate Court Division _____________ Municipal Court Division _____________ Criminal Records Repository _________________________ County Sheriff's Dept. _________________________ Municipal Police Dept _________________________ Missouri Highway Patrol Troop Prosecutor's Office (include name of county or city) County ____________________________________ Municipal __________________________________ Other (include name and address of agency): Petition for Expungement of Arrest Records Pursuant to Section 610.122, RSMo, I request that the court issue an order to expunge my record of arrest, for the following criminal case: I am filing this petition in the county where the arrest occurred and I hereby swear that I have no prior or subsequent misdemeanor or felony convictions and I did not receive a suspended imposition of sentence (SIS) for the offense for which the arrest was made or for any offense related to the arrest. I also state that the arrest was based on false information; there is no probable cause at the time of the action to expunge to believe that I committed the offense; no charges will be pursued as a result of the arrest; and no civil action is pending relating to the arrest or the records sought to be expunged. I am providing my fingerprints on a standard fingerprint card for verification of my identity. I am filing this petition in the county where the arrest occurred and I hereby swear that I have no prior or subsequent misdemeanor or felony convictions. I was arrested for, or was subsequently charged with, a misdemeanor offense of chapter 303 or a moving violation as the term "moving violation" is defined under section 302.010, RSMo, except for any intoxication-related traffic offense as "intoxication-related traffic offense" is defined under section 577.023, RSMO; and each offense or violation related to the arrest was subsequently nolle prossed or dismissed, or I was found not guilty of each offense or violation; I am not a commercial driver's license holder and was not operating a commercial motor vehicle at the time of the arrest; and no civil action is pending relating to the arrest or the records sought to be expunged. I am providing my fingerprints on a standard fingerprint card for verification of my identity. I have reason to believe the agencies named above as defendants may possess records subject to expungement. Full Name Date of Birth Address at Time of Arrest Date of Arrest Arrest Citation Number Social Security Number Sex M F Race Driver's License Number Offense Charged If criminal charges were filed, date of dismissal or reversal Name of Arresting Agency County where Petitioner was arrested (if Arrest Occurred in a Municipality, also Name Municipality) Case Number and Division of Court of the Offense Circuit Associate Municipal Not Applicable Division ____________ #_______________________________________________________ OSCA (07-14) CR145 1 of 2 Chapter 610 RSMo American LegalNet, Inc. www.FormsWorkFlow.com I swear the facts stated in the above petition are true according to my best knowledge and belief. _____________________________________ Petitioner's Signature/Address _____________________________________ _____________________________________ Subscribed and sworn to before me this ___________ day of ___________________________, ____________ My commission expires: _______________________ _____________________________________ Notary Public/Judge/Clerk Instructions to Clerk 1. A copy of the petition shall be issued to the prosecuting attorney. 2. A copy of the petition and the fingerprint card should be sent to the Missouri Criminal Record Repository. 3. Give notice of the hearing to the prosecuting attorney and each official, or agency, or other entity named in the petition. OSCA (07-14) CR145 2 of 2 Chapter 610 RSMo American LegalNet, Inc. www.FormsWorkFlow.com