IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINCOLN, 17TH JUDICIAL DISTRICT STATE OF OREGON, Plaintiff v. Defendant. ) ) ) ) ) ,) ) CASE # AFFIDAVIT IN SUPPORT OF MOTION TO SET ASIDE CONVICTION STATE OF OREGON County of Lincoln ) ) ) SS. I, Defendant's Name do hereby depose and say: 1. I am the defendant herein, and I am filing this Affidavit in Support of my Motion to Set Aside Conviction and Record of Arrest pursuant to ORS 137.225; This conviction occurred more than three years ago; I have no criminal cases presently pending against me in any Court; I have had no other criminal convictions in the ten-year period immediately preceding the filing of this motion; I have not had another conviction set aside within the ten-year period immediately preceding the filing of this motion; I have fully complied with and performed all provisions of the sentence herein; I served a copy of the Motion, Affidavit and Order to set aside conviction and a full set of my fingerprints on the Lincoln County District Attorney's Office on ____________________. (Date Served) 2. 3. 4. 5. 6. 7. Dated: Defendant's Signature SUBSCRIBED AND SWORN to before me this of , 20 . Notary Public My Commission Expires: American LegalNet, Inc. www.FormsWorkFlow.com