NHJB-2721-D (03/29/2019) Page 1 of 1 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Charge ID: MOTION TO AMEND RECORD I, , hereby swear or affirm that: Defendant222s name 1. I was convicted of DWI 226 1st Offense in the above captioned court on 2. At least one year has passed since my conviction: (Date of Conviction) 3. I have completed and complied with all the terms and conditions of my sentence including any drug and/or alcohol treatment recommended by the Impaired Driver Care Management Program. 4. I have had no further motor vehicle convictions since my conviction for DWI 226 1st Offense. 5. I would benefit from having the criminal conviction removed from my record. Pursuant to RSA 265-A:18,I(a)(6)(C) I hereby move that the record of this conviction for DWI 226 1st Offense be reduced from a Class B misdemeanor to a violation and that both my criminal and motor vehicle records be amended accordingly. I certify that on this date I provided a copy of this document to the prosecutor of record (insert name) by Hand-delivery OR US Mail. Verification: I verify the truth and accuracy of all facts alleged within this document to the best of my belief and further verify that all facts contained in this document are alleged in good faith. By affixing my signature to this document I acknowledge my understanding that any false statements made in this document are punishable as perjury which may include a fine or imprisonment or both. Date: Defendant222s signature -------------------------------------------------------------------------------------------------------------------------------------- Motion to Amend Record is: Granted Denied Date Signature of Judge Printed Name of Judge American LegalNet, Inc. www.FormsWorkFlow.com