IN THE COURT OF COMMON PLEAS, FRANKLIN COUNTY, OHIO CRIMINAL DIVISION In the Matter of: ______________________________________ Sealing Case No. ________________________________ Criminal Case Number(s): _________________ _________________ _________________ _________________ Application for Order Sealing Record of Conviction or Bail Forfeiture [R.C. 2953.32(A)] ___________________________________________, applies to the Court for an Order sealing [Name of applicant] all official records of ________________________________ for a ____________________________ [Indicate conviction or bail forfeiture] [Indicate felony or misdemeanor] in criminal Case No. ___________________ Court of Common Pleas, Franklin County, Ohio, as provided in Section 2953.32 of the Ohio Revised Code. Applicant was convicted or forfeited bail on the _____ day of ___________________________, ___________. [month] [year] ____________________________________ Applicant, PRO SE ____________________________________ Address ________________________________________ City, State, Zip Code Memorandum in Support of Application for Order Sealing Record Applicant is an eligible offender as defined in R.C. 2953.31; and more than three years have passed since applicant's conviction of a felony (more than one year if conviction or bail forfeiture for a misdemeanor). Applicant otherwise satisfies the requirements of R.C. 2953.32 for granting this application. The applicant is not indigent and deposits herewith the sum of fifty dollars, ($50.00 plus a non-refundable e-filing convenience fee when applicable), as set forth in R.C. 2953.32; or applicant claims to be indigent and has attached a Financial Disclosure and Affidavit of Indigency as Exhibit A to this application. ____________________________________ Applicant, PRO SE American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT'S FULL NAME: ________________________________________________ SEX: _________________ RACE: _____________ DATE OF BIRTH: ______________ SSN: _________________ ADDRESS: ________________________________________ CITY: ________________________ STATE: _____________________ ZIP: ________ TELEPHONE NO. ________________________ American LegalNet, Inc. www.FormsWorkFlow.com