IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN State of Oregon, Plaintiff, v. _______________________________, Defendant. STATE OF OREGON ) ) ss COUNTY OF LINN ) Affidavit in Support of Motion to Set Aside Records of Arrest and Conviction Case No. _________________ I, _____________________________, do hereby depose and say that: I am the Defendant herein, and I am filing this Affidavit in Support of my Motion to Set Aside Conviction and to seal the records of my arrest. This conviction occurred more than three (3) year ago. I have no criminal cases presently pending against me in any court. I have no criminal convictions in the ten (10) year period immediately preceding the filing of this motion, excluding motor vehicles violations. I have not had another conviction set aside within the ten (10) year period immediately preceding the filing of this Motion and have no other similar motions pending in this or any other court. I have fully complied with and performed all provisions of the sentence herein. A copy of this Affidavit and a copy of my Motion to Set Aside Conviction and Seal Records of Arrest have been served upon the District Attorney of Linn County. A complete set of my fingerprints, along with a certified check made payable to the Oregon State Police for their processing costs, has been served on the District Attorney of Linn County. I am not now charged with the alleged commission of any crime. The arrest that I am seeking to have set aside occurred on ____________________. The charge(s) that I was arrested for on the above date were ______________________________________________________________________________ Arresting agency and incident number (if known): ________________________. The charge(s) that I was convicted of was/were ______________________________________________________________________________ The date of my conviction was ____________________________ Linn County Expungement Packet C Affidavit in Support of Motion to Set Aside Records of Arrest Page 1 of 2 EXPUNGEMENT PACKET C.doc American LegalNet, Inc. www.FormsWorkFlow.com This conviction was not a Class A felony, or a Class B felony (excluding possession or delivery of a controlled substance.) Dated this _____ day of ___________________, ______. ____________________________________ Signature of Defendant SUBSCRIBED AND SWORN TO before me this _____ day of ___________________, _____. _______________________________________ Notary Public of Oregon/Deputy Clerk of Court My Commission Expires: ______________ Linn County Expungement Packet C Affidavit in Support of Motion to Set Aside Records of Arrest Page 2 of 2 EXPUNGEMENT PACKET C.doc American LegalNet, Inc. www.FormsWorkFlow.com