COURT COUNTY .OF. . . . . . . . . . . . . . . . . . .(FOR. TBI USE.ONLY) .State.Identification Number: ______________________________ ......... .. ... ...... ..... ... .. : Index No. (FOR TBI USE ONLY) FBI Identification Number: ______________________________ ORDER FOR THE EXPUNGEMENT OF CRIMINAL OFFENDER RECORD (PLEASE PRINT OR TYPE) : Calendar No. State of Tennessee vs _______________________________________________ Circuit Docket Number_______________________ : JUDICIAL SUBPOENA Plaintiff(s) Date Original Case was filed in Clerk’s Office___________________ General Sessions Docket Number_______________________ : In the ____________________Court -againstof __________________________ County, Tennessee at _______________________________ On the Motion or Petition of ______________________________________________________ : Defendant/Arrest Information: : _________________________________________________________________________ Defendant (name used at time of arrest) Defendant(s) : ...................................................... _____ Race ____ Sex ___________ Date of Birth ________________________________________________________________ Arresting Agency _____________ __________________ OCA# Date of Arrest ___________________________________________________________________ Charge 1(As shown on arrest fingerprint OF NEW YORK THE PEOPLE OF THE STATE card) ________________________________ SSN# ________________________________________________________________________________________________________ TO Charge 2(As shown on arrest fingerprint card) ________________________________________________________________________________________________________ Charge 3(As shown on arrest fingerprint card) Disposition Information: GREETINGS: ________________________________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Final Charge 1 the Honorable at the Court ________________________________________________________________________________________________________ located at County of Final Charge 2 in room , on the day of , 20 , at o'clock in the noon, and at any recessed ________________________________________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the Final Charge 3 ________________________________________________________________________________________________________ Final Disposition Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ________________________________________________________________________________________________________ a the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as Diversion Date (if applicable) comply. result of your failure to The defendant named above is entitled to have all PUBLIC RECORDS relating to the offenses listed above expunged according to the Tennessee Code Annotated provision marked below:Honorable Witness, , one of the Justices of the Provision relating to Adults: Court in County, day of ___Charge has been dismissed (T.C.A. § 40-32-101) ___No true bill returned by Grand Jury (T.C.A. § 40-32-101) ___Verdict of not guilty returned by jury (T.C.A. § 40-32-101 ___Conviction which has by appeal been reversed (T.C.A. § 40-32-101) ___Nolle Prosequi entered in case (T.C.A. § 40-32-101) ___Successful completion of all probation provisions and proceedings against defendant have been discharged by the court (T.C.A. § 40-35-313) ___Suspension of prosecution pursuant to T.C.A. § 40-15-105 Provisions relating to Juveniles: , 20 ___Petition alleging delinquency not filed (T.C.A. § 37-1-155) ___Proceedings dismissed after petition is filed or the case transferred to Juvenile Court as provided in T.C.A. § 37-1-109 (T.C.A. § 37-1-155) ___Adjudicated not to be a delinquent child (T.C.A. § 37-1-155) (Attorney must sign above and type name below) ___Child has reached eighteen (18) years of age and there is no record that he committed a criminal offense after reaching sixteen (16) years of age, unless such fingerprints were obtained on alleged charge which if committed by an adult would be a felony (T.C.A. § 37-1-155) ___Passage of six (6) months from date of liquor law violations defined by Attorney(s) for T.C.A. § 57-3-412(a)(3)(c) or T.C.A. § 57-5-301(e)(3) It is ordered that all PUBLIC RECORDS relating to such offense above referenced be expunged and immediately destroyed upon payment of all costs 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 T.C.A. § 10-7-504 and T.C.A. § 38-6-118. Office and P.O. Address APPROVED FOR ENTRY ________________________________________________ Defendant/Attorney for Defendant ________________________________________________ District Attorney General Form EX-1 (Rev. 2003) Entered this ______________ day of _______________, _______ Telephone No.: Facsimile No.: __________________________________________________________ E-Mail Address: Judge Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com ,