100212 IN THE BOWLING GREEN MUNICIPAL COURT State of Ohio/ City of Bowling Green Plaintiff, VS. _______________________________ Name * * * Case No. _____-CR___-____________ _______________________________ Address * * * * JUDGE MARK B. REDDIN _______________________________ City, State, ZIP * * (_____)_________________________ Phone * * * APPLICATION FOR SEALING OF RECORD _____-____-_______ ____/____/____ Social Security Number Date of Birth * * * Defendant makes application to this Court: For the sealing of his/her official record of conviction in this case 1. More than one (1) year has passed since the final discharge in the above titled case (in cases of conviction and bail forfeiture). 2. Applicant is an eligible offender pursuant to the definition found in R.C. 2953.31 (A) and there are no criminal proceedings pending against me. 3. Applicant has been rehabilitated. 4. Applicant's conviction/bail forfeiture is not a crime listed in R.C. 2953.36 for which the sealing of the record provisions of R.C. 2953.31 to 2953.35 are inapplicable. 5. The applicant understands that the $50.00 filing fee is non-refundable. 6. The sealing of this record is consistent with public interest. For the sealing of his/her official record of dismissal in this case. ____/____/____ Date __________________________________________ Signature of Defendant/Attorney for Defendant American LegalNet, Inc. www.FormsWorkFlow.com 100212 AFFIDAVIT STATE OF _____________________ COUNTY OF _______________________________, SS: ____________________________________, the undersigned defendant, being duly sworn says: On____/____/____, in this court, the defendant was convicted of: Code & Section #_______________ Name of Offense__________________________________ I, _____________________________, after having reviewed the applicable statutes referenced above in order to determine my eligibility for the sealing of the record of my case, in order to make truthful assertions for the purposes of this application; hereby swear or affirm under the penalty of Falsification (R.C. 2921.13) that the statements contained herein are true and petitions the Court for an order sealing the record pursuant to ORC 2953.36, or 2953.51 ­ 2953.55 and 2953.61. ____________________________________ Signature of Defendant On this _____ day of __________________, 20______, sworn to before me and subscribed in my presence. _______________________________________ Notary Public NOTICE OF HEARING This matter shall be set for hearing by the Court upon completion of a record check as required by statute. Notice of the date and time of hearing shall be forwarded to all parties. If an attorney is assisting you with sealing this record, please list their contact information below. ___________________________________ Name _______________________________________ Address _________________________________________________ __________________________________ Phone American LegalNet, Inc. www.FormsWorkFlow.com