REQUEST FOR EXPUNGEMENT - MDJ# COURT ORDER# - Docket# OTN# Defendant Name Please check the following prior to mailing to AOPC: Has the court order been signed? Is a copy of the court order enclosed? Is this a partial expungement? Yes No Specify charges to be expunged as indicated on the court order. Specify charges that should remain as indicated on the court order. Is there one defendant specified on the court order for expungement while others should remain on the case? Yes No What is the name of the defendant to be expunged? Which defendant(s) shall remain on the case? Case was archived and has been restored. AOPC Use Only Lawyer Defendant Clerk of Courts Tape ID not found Case not in auto system Case expunged Multiple expunged Incomplete documentation Prev expunged Def & doc# differ Not submitted in a timely manner Other AOPC 101-05 American LegalNet, Inc. www.USCourtForms.com