File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF: Name And Address Of Petitioner PETITION AND MOTION IN THE CAUSE FOR EXPUNCTION OF JUVENILE RECORD (UNDISCIPLINED/DELINQUENT) Date Of Birth Age G.S. 7B-3200 I petition the Court to order the expunction of all records dated (date of adjudication) in which I was adjudicated undisciplined delinquent for the offense of (specify offense) . In support thereof I respectfully show that I have: (Applicable to all petitioners) 1. Attained the age of 18 years. 2. Been of good behavior since the adjudication. 3. Attached to this petition two verified affidavits of good character, pursuant to G.S. 7B-3200(c)(2) (see Affidavit of Good Character, AOC-J-904M). (Applicable only when the adjudication was for delinquency.) 4. The offense for which I was adjudicated delinquent would not have been a Class A-E felony if committed by an adult. 5. At least eighteen (18) months have elapsed since I was released from juvenile court jurisdiction and I have not been adjudicated delinquent again or convicted as an adult of any felony or misdemeanor other than a traffic violation under the laws of the United States or the laws of this State or any other State. I request that: 1. This petition be treated as an affidavit. 2. An order be issued to expunge the records of the adjudication as provided by G.S. 7B-3200. SWORN AND SUBSCRIBED TO BEFORE ME Signature Of Official Authorized To Administer Oaths Title Date Date Notary Commission Expires Signature Of Petitioner SEAL HEARING ON PETITION Date of Hearing Time Of Hearing Date AM PM Place Of Hearing Signature Date Petition Filed Deputy CSC Assistant CSC Clerk Of Superior Court CERTIFICATE OF SERVICE I certify that a copy of this motion was served by: delivering a copy personally to the prosecutor. depositing a copy enclosed in a postpaid properly addressed envelope in a post office or official depository under the exclusive care and custody of the U.S. Postal Service directed to the prosecutor. leaving a copy at the office of the prosecutor with an associate or employee. Name Of Person With Whom Copy Left (Type or Print) Signature Of Person Serving Date Served Service accepted by the prosecutor. Signature Of Person Accepting Service Date Service Accepted AOC-J-903M. Rev. 3/02 2002 Administrative Office of the Courts