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Order For Expungement Of Record Form. This is a Utah form and can be use in Expungement Of District Court Record Statewide.
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Tags: Order For Expungement Of Record, Utah Statewide, Expungement Of District Court Record
__________ District Court
____________ County, State of Utah
______________________________
Petitioner
______________________________
Address
______________________________
Birthdate
Petitioner.
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PETITION FOR EXPUNGEMENT
OF RECORD
Case No. _________________
Judge ____________________
Petitioner petitions this Court for an order of expungement of any and all records relating to the following
1.
Petitioner was arrested on ___________, 20__ by __________________ (law enforcement
agency) under law enforcement file number_________ for the following crime(s) and/or charge(s), (with the
appropriate code or ordinance citation), arising out of the same criminal episode:
__________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
filed under the following case number(s):______________________________________________
_________________________________________________________________________________
2.
With regard to the crime(s) and/or charge(s), the following has occurred (check a, b or c, and all
other appropriate boxes):
( ) a. 30 days have passed since arrest, there have been no intervening
arrests, and one of the following has occurred:
()
Petitioner was released without the filing of formal charges
()
Proceedings against Petitioner were dismissed on _______________
()
Petitioner was discharged without a conviction and no new charges
were filed within 30 days
()
The Petitioner was acquitted at trial
( ) b. 30 days have not passed since the time of arrest, but the following
extraordinary circumstances exist for granting the expungement:
_______________________________________________________________
_______________________________________________________________
( ) c. Petitioner was convicted in this Court on __________, 20__, for the crime(s) of
____________________________________________________
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3.
____________________________________________________________
Pursuant to Utah Code Ann. § 77-18- 12, Petitioner has obtained an expungement
certificate from the Law Enforcement and Technical Services Division of the Department
of Public Safety (the Utah Bureau of Criminal Identification), which is attached to this
petition and which shows that Petitioner is eligible to have the conviction expunged.
Check one of the following:
( )
Petitioner requests that all records in the petitioner’s case be expunged
( )
Petitioner requests that only the following records be expunged:
____________________________________________________________
____________________________________________________________
____________________________________________________________
( )
Petitioner requests that only petitioner’s name be expunged from all records
Dated this ____ day of ______________ 20__.
______________________________________
Counsel for Petitioner/Pro Se Petitioner
Mailing Certificate
I certify that I have served (either by first class mail or hand delivering) Petitioner's Petition for
Expungement of Records, and the expungement certificate issued by the Law Enforcement and Technical Services
Division of the Department of Public Safety, to the prosecuting attorney and the Department of Corrections at the
following addresses:
________________________________
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__________ District Court
____________ County, State of Utah
______________________________
Petitioner
______________________________
Address
______________________________
Birthdate
Petitioner.
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ORDER FOR EXPUNGEMENT
OF RECORD
Case No. _________________
Judge ____________________
The Court having reviewed Petitioner's Petition for Expungement of Records and having found as follows:
1.
That Petitioner was arrested on _________________ (date) by ________________
_______________ (law enforcement agency) for the following charges:____________________
_______________________________ filed under the following case number(s):_____________
________________________________________;
2.
The Petitioner has met all of the conditions for expungement and the Court is satisfied that there
are no reasonable objections to Petitioner's petition;
IT IS HEREBY ORDERED:
1.
( )
All records in Petitioner's case in the custody of this court, any other court, or any state,
county or local entity, agency or official, as identified in the above petition, shall be sealed pursuant to Utah Code
Ann. § 77-18-14.
OR
( )
The following records in Petitioner’s case shall be expunged:
____________________________________________________________
____________________________________________________________
____________________________________________________________
( )
References to Petitioner’s name shall be removed from records in Petitioner’s case in the
custody of this court, any other court, or any state, county or local entity, agency, agency or official pursuant to
Utah Code Ann. § 77-18-14.
2.
Petitioner shall distribute this order to all affected agencies and officials including the arresting
agency, the booking agency, the prosecutor's office, the Department of Corrections, the Law Enforcement and
Technical Services Division of the Department of Public Safety (the Utah Bureau of Criminal Identification), the
Board of Pardons, and all interested courts.
DATED this _________ day of ______________________, 20 __.
______________________________________
_____________ COURT JUDGE
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__________ District Court
____________ County, State of Utah
______________________________
Petitioner
______________________________
Address
______________________________
Birthdate
Petitioner.
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RECEIPT, CONSENT AND
WAIVER OF HEARING
Case No. _________________
Judge ____________________
The undersigned acknowledges receipt of a copy of Petitioner's Petition for Expungement. The
undersigned waives the right to object to Petitioner's Petition and consents to this court entering an Order for
Expungement of Records without further hearing.
DATED this ________ day of ______________________, 20__.
______________________________________
Prosecutor
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__________ District Court
____________ County, State of Utah
______________________________
Petitioner
______________________________
Address
______________________________
Birthdate
Petitioner.
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ORDER FOR EVALUATION
Case No. _________________
Judge ____________________
The Court having reviewed Petitioner's Petition for Expungement and the Court having determined that
a written evaluation may be helpful in this matter,
IT IS HEREBY ORDERED that the Adult Parole and Probation of the Department of Corrections shall
prepare a written evaluation on the Petitioner and submit it to the Court and the prosecuting attorney pursuant
to Utah Code Ann. §77-18-11. The written evaluation shall contain a recommendation on expungement.,
Dated this ______ day of ________________, 20__.
BY THE COURT:
______________________________________
______________ COURT JUDGE
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__________ District Court
____________ County, State of Utah
______________________________
Petitioner
______________________________
Address
______________________________
Birthdate
Petitioner.
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NOTICE TO SUBMIT
FOR DECISION
Case No. _________________
Judge ____________________
Petitioner filed a Petition for Expungement and Sealing of Record on _____________, 20__, along with
an expungement certificate issued by the Law Enforcement and Technical Services Division of the Department of
Public Safety. These documents were served upon the prosecuting attorney and the Department of Corrections more
than 30 days ago and the prosecuting attorney has not objected to the petition or requested a hearing. The court
has not received a request for hearing from any victim and therefore Petitioner requests that this Court grant
Petitioner's petition and execute the accompanying Order, or set forth its reasons for denying to do so.
Dated this _____ day of _____________, 20__.
_________________________________
Counsel for Petitioner/Pro Se
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Mailing Certificate
I certify that I have mailed the Notice to Submit for Decision on Petitioner's Verified Petition for
Expungement and Sealing of Records to the prosecuting attorney at the following address:
________________________________
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