200-00130 226 Petition to Expunge or Seal Criminal History (01/2019) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT CRIMINAL DIVISION Unit Docket No. In RE: DOB PETITION TO EXPUNGE OR SEAL CRIMINAL HISTORY The above-named Defendant hereby requests that the Court order that his/her criminal history record be expunged or sealed. As grounds for the request, Defendant hereby states as follows: 1. Charges: I am requesting that the criminal records for the following offense(s) be expunged or sealed: Description of Offense Year Docket Number (If Any) 1. 2. 3. If more than one offense is listed, the offenses must relate to the same incident. 2. Record of Convictions: I was convicted of the offenses. If you were convicted, please provide the following about your conviction: a. Date of conviction: b. I completed all of the conditions of my probation: Yes 226 Date of Completion: No c. Any restitution ordered by the Court has been paid: Yes No Restitution was not ordered I was not convicted for the offenses listed above. If you were cited or arrested for the offense, but never convicted, answer the following questions and then skip to question 3. I was cited or arrested, by (name of arresting law enforcement agency or department) , but a charge was never filed with the Court. A charge was filed, but the Court did not find probable cause. A charge was filed and later dismissed by the Court. 3. List any new charges or convictions you have received since the date of the offense listed in question 1. Offense Date of Offense Date of Charge Date of Conviction 4. I am requesting that my criminal history record be: Expunged (all records destroyed except certificate of expungement) Sealed (records maintained but under seal meaning they are not public) American LegalNet, Inc. www.FormsWorkFlow.com 200-00130 226 Petition to Expunge or Seal Criminal History (01/2019) Page 2 of 2 5. I believe that expungement or sealing of my criminal history is in the interests of justice because: Date of Signature Signature of Defendant Printed Name of Defendant Address City, State, Zip Phone Email Address cc: State222s Attorney or Attorney General222s Office American LegalNet, Inc. www.FormsWorkFlow.com