EXPUNGEMENT APPLICATION Attached is the application form that is required by the Delaware Municipal Court in order to apply for a record to be sealed. If you have any questions concerning this form you must contact an attorney. Please note that this form must be notarized before filing. The filing fee of $50.00 must accompany the application. If the case was dismissed or the defendant was found "not guilty" the filing fee is $25.00. This can be a certified check or money order made payable to the Delaware Municipal Court. American LegalNet, Inc. www.FormsWorkFlow.com DELAWARE MUNICIPAL COURT JUSTICE CENTER 70 North Union Street Delaware, Ohio 43015 R.C. 2953.31 030105 State/City/Village of Plaintiff, vs. Defendant (name, address, AC & tel. no.): Case No. ____________________________ APPLICATION To Seal Record of First Offense (Conviction) NOTE: Please print or type this application and affidavit NOTE: A conviction (a "yes" answer) under � 3.a.(1)-(7) or 3.b.(2) disqualifies the defendant from a sealing of their record. DOB: _______/_______/_______ SSN: _______-_______-_______________ Defendant's Atty. (name, address, AC & tel. no.): Defendant applies for expungement of the records in this case, and tenders herewith the $50.00 or $25.00 filing fee, an affidavit, and an authorization for release of information. (More than (X one): G one year has expired since defendant's final discharge on a misdemeanor conviction (see page 2, para. 2); G three years have passed since defendant's final discharge on a felony conviction (see page 2, para. 2); ____/____/____ Attorney for defendant ____/____/____ Defendant 1 American LegalNet, Inc. www.FormsWorkFlow.com To be completed and signed by the defendant. AFFIDAVIT STATE OF __________________________ COUNTY OF _________________________________, SS: _____________________________, the undersigned defendant, being duly sworn says: 1. On _____/_____/_____, in this court, the defendant was convicted of: Code & Section # Name of Offense NOTE: The following cannot be sealed, per R.C. 2953.36: Convictions when the offender is subject to a mandatory prison term; convictions under section 2907.02 (Rape), 2907.03 (Sexual Battery), 2907.04 (Unlawful Sexual Conduct With a Minor), 2907.05 (Gross Sexual Imposition), 2907.06 (Sexual Imposition), 2907.321 [2907.32.1] (Pandering Obscenity Involving a Minor), 2907.322 [2907.32.2] (Pandering Sexually Oriented Matter Involving a Minor), or 2907.323 [2907.32.3] (Illegal Use of Minor in Nudity Oriented Material or Performance), former section 2907.12, or Chapter 4507 (Driver's License Law), 4510 (Driver's License Suspension Cancellation Revocation), 4511 (Traffic Laws/Operation of Motor Vehicle), or 4549 (Motor Vehicle Crimes) of the Revised Code, or a conviction for a violation of a municipal ordinance that is substantially similar to any section contained in any of those chapters; convictions of an offense of violence when the offense is a misdemeanor of the first degree and when the offense is not a violation of 2917.03 (Riot), 2903.13 (Assault), 2917.01 (Inciting to Violence), or 2917.31 (Inducing Panic); convictions of an offense in circumstances in which the victim of the offense was under eighteen years of age when the offense is a misdemeanor of the first degree or felony; or bail forfeitures in a traffic case. 2. On _____/_____/_____, the defendant completed the sentence in full and was finally discharged. (NOTE: the discharge date is the latest of the following: defendant's date of sentencing, his/her last day of jail confinement, or his/her last day of probation). 3. First offender status [R.C. 2953.31(A)]. a. Past traffic offense convictions. At any time, have you ever been convicted of any of the following traffic offenses in Ohio or in any other jurisdiction, whether under the Revised Code of Ohio or a substantially similar Ohio municipal ordinance, or under the laws and ordinances in another state: (1) Operating a motor vehicle while under the influence of alcohol and/or drugs? [R.C. 4511.19 or a municipal ordinance]. (2) Driving while under a suspension imposed for refusal to submit to a test for determining alcohol content? [R.C. 4511.192 or a municipal ordinance]. (3) Drag racing? [R.C. 4511.251 or a municipal ordinance]. (4) Leaving the scene of an accident? [R.C. 4549.02; 4549.021; 4549.03; or a municipal ordinance]. G Yes G No G Yes G No G Yes G Yes G No G No 2 American LegalNet, Inc. www.FormsWorkFlow.com (5) Sale or possession of master keys for illegal purposes? [R.C. 4549.042 or a municipal ordinance]. (6) Motor vehicle with a concealed number or identification mark? [R.C. 4549.07 or a municipal ordinance]. (7) Odometer rollback and disclosure violation? [R.C. 4549.41 through 4549.46 or a municipal ordinance]. G Yes G No G Yes G No G Yes G No b. Past non-traffic offense convictions. In addition to the above traffic offenses, at any time, have you ever been convicted of any non-traffic offense in Ohio or in any other jurisdiction? G Yes G No If "yes", state for each the name of the offense, and the name and location of the court. (1) Minor Misdemeanors: (2) Higher misdemeanors, and any felonies: NOTE: A conviction (a "yes" answer) under � 3.a.(1)-(7) or 3.b.(2) disqualifies the defendant from a sealing of their record. c. Pending traffic or non-traffic cases. Are there any pending cases against you in any court in Ohio or elsewhere? G Yes G No If "yes", state for each the name of the offense, and the name and location of the court. 3 American LegalNet, Inc. www.FormsWorkFlow.com 4. Residence. Concerning your conviction in this case, the defendant's places of residence between the sentencing date (� 1) and now have been: Beginning and Ending Dates Street, City, State, and Zip 5. Employment: Concerning your conviction in this case, the defendant's places of employment between the sentencing date (� 1) and now have been: Name of Employer Street, City, State, and Zip Name of Supervisor Beginning and Ending Dates 4 American LegalNet, Inc. www.FormsWorkFlow.com 6. Rehabilitation. Defendant's rehabilitation has been attained and expungement of the record of defendant's conviction is consistent with the public interest, for the following reasons: 7. Statement: Attached hereto is defendant's handwritten statement setting out facts, not just conclusions on the following three topics: (a) Why the expungement is deserved (not only for job reasons), (b) what positive contributions have been made to