_______________JUVENILE COURT FOR___________________COUNTY, STATE OF UTAH ______________________________________________________________________________ State of Utah, in the interest of PETITION FOR EXPUNGEMENT OF RECORD Name: ______________________________ Address: ____________________________ CASE NO: ____________ Date of Birth: ________________________ A person eighteen years or older ___________________________________________________________________________ Parent’s Names: ________________________________________________________________ Comes now, _______________________________________________ and, pursuant to Section 78-3a-905, U.C.A. 1953, as amended, hereby petitions this Court to expunge my juvenile record in whole or in part. In support of such petition, I allege under oath the following: 1. My full and correct name, the date and year of birth and the names of my parents are as set forth above. 2. That Juvenile Court jurisdiction and/or custody and parole supervision of the Division of Youth Corrections was unconditionally terminated on _____________________ and that one year has expired since such date. 3. ( ) I have not been convicted of a felony level criminal offense or of a misdemeanor level offense involving moral turpitude and no such charge or proceeding is pending or being instituted against me in any other Court. ( ) I have been convicted of a felony level criminal offense or of a misdemeanor level offense involving moral turpitude and a charge or proceeding is pending or being instituted against me. 4. Since my 18th birthday I have resided at the following address(es): 5. That I am a responsible and law-abiding citizen of good moral character. Dated: _____________________________ Signed, _________________________________ Petitioner Subscribed and sworn to before me on ______________________________________________ ______________________________________________ Clerk/Deputy Clerk/Notary American LegalNet, Inc. www.USCourtForms.com