COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Add. . . . . . . _________________________________________________ CPN _______________________________ : Index No. City ___________________________ St. _____ Zip_____ Phone _____________________________ Date Received ______________________ Cost Rec. # _____________ Date Pd _____ Exp. Rec. # _____________ Date Pd _____ : Calendar No. ORDER FOR THE EXPUNGEMENT OF CRIMINAL OFFENDER RECORD : JUDICIAL SUBPOENA Plaintiff(s) State of Tennessee vs._________________________________ -against- Criminal Docket No.__________________ : General Sessions Docket No.__________________ : In the __ _______________________________Court of Davidson County, Tennessee at Nashville On Motion or Petition of________________________________________ : Defendant/Arrest Information: Defendant(s) : . . . . .Defendant.(Name.Used.at Time of.Arrest). . . . . . . . . . . . . . . . . . . . . . . Race . ..... ... .. ..... ... ... ___________________________________________________ Arresting Agency ___________________________________________________ Charge 1 (As shown on Arrest Fingerprint Card) THE ________________________________________________________________ PEOPLE OF THE STATE OF NEW YORK Sex Date of Birth ________ _________ ____________ OCA# Date of Arrest _________________ _______________________ SSN# __________________________ Charge 2 (As shown on Arrest Fingerprint Card) TO ________________________________________________________________ Charge 3 (As shown on Arrest Fingerprint Card) _______________________________________________________________ Disposition GREETINGS:Information: Final Charge 1 _____________________________________________________________________________________ Final Charge 2 WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before _____________________________________________________________________________________ the Honorable 3 at the Court Final Charge _____________________________________________________________________________________ located at County ofDisposition Final _____________________________________________________________________________________ in the in room , on the day of , 20 , at o'clock noon, and at any recessed Diversion or adjourned Date (if to testify and give evidence as a witness in this action on the part of the date, applicable) ________________________________________________________ The defendant named above is entitled to have all PUBLIC RECORDS relating to the offense listed above expunged according to the Tennessee Code Annotated provision marked below: Provisions Relating to Adults: P rovisions Relating to Juveniles: ____ Charge has been dismissed (TCA 40-32-101) ____ Petition alleging delinquency not filed (TCA 37-1-155) ____ Proceedings dismissed after petition is filed or the case ____ No true bill returned by Grand Jury (TCA 40-32-101) is transferred to the Juvenile Court as provided in TCA 37-1-109 (TCA 37-1-155) ____ Verdict of not guilty returned by jury (TCA 40-32-101) ____ Adjudicated not to be a delinquent child (TCA 37-1-155) ____ Child has reached eighteen (18) years of age and there ____ Conviction which has by appeal been reversed (TCA is no record that he committed a criminal offense after 40-32-101) reaching sixteen (16) years of age, unless such fingerprints were obtained on alleged charge which if committed by an adult ____ Nolle prosequi entered in case (TCA 40-32-101) would be a felony (TCA 37-1-155) ____ Passage of six (6) months from date of liquor law ____ Successful completion of all probation provisions and violations defined by TCA 57-3-412(a)(3)(c) or TCA proceedings against Defendant have been discharged by the 57-5-301(e)(3) court (TCA 40-35-313) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) ____ Suspension of prosecution pursuant to TCA 40-15-105 It is ordered that all PUBLIC RECORDS relating to such offense above referenced be expunged and immediately destroyed upon payment of all cost to clerk and that no evidence of such records pertaining to such offense be retained by any municipal, county or state agency, except non-public confidential information retained in accordance with TCA 10-7-504 and TCA 38-6-118 Attorney(s) for APPROVED FOR ENTRY Entered this __________day of ___________, ________ ________________________________________ Defendant / Attorney for Defendant _________________________ Bar ID AOC- _________________________________________ Assistant District Attorney Office and P.O. Address _____________________________________________________ Judge ______________Court of Davidson County, Div._____________ Telephone No.: Facsimile No.: E-Mail Address: _________________________________________ Date Mobile Tel. No.: RDA Pending American LegalNet, Inc. www.USCourtForms.com ,