200-00132 226 Stipulation to Expunge or Seal Criminal History Record + Order (09/2018) Page 1 of 1 STATE OF VERMONT SUPERIOR COURT CRIMINAL DIVISION Unit Docket No. In RE: STIPULATION TO EXPUNGE OR SEAL CRIMINAL HISTORY RECORD We, the undersigned Defendant and State222s Attorney, hereby agree that the offense(s) meet the requirements for expungement or sealing pursuant to 13 V.S.A. 2477602 and that the Court may issue an Order to: Expunge Seal the criminal history record for the offense(s) described below: Description of Offense Date of Offense Incident Number Docket Number (if any) I was cited or arrested by (name of arresting law enforcement agency or department) , but a charge was never filed with the Court. We further understand that the effect of this Order will be to expunge or seal any records of arrest, conviction or sentencing for this/these offense(s) and that the Defendant will hereafter be treated in all respects as if he or she had never been arrested, convicted of sentenced for the offense(s). Dated Signature of Defendant Signature of State222s Attorney ORDER Based upon the agreement of the Defendant and the State222s Attorney and pursuant to 13 V.S.A. 2477602, it is hereby ORDERED that criminal history record of the offense(s) described above be: Expunged Sealed All records related to the arrest, conviction or sentencing for this/these offense(s) shall be expunged or sealed and that the Defendant will hereafter be treated in all respects as if he or she had never been arrested, convicted of sentenced for the offense(s). Dated of Signature Signature of Superior Court Judge Printed Name of Judge American LegalNet, Inc. www.FormsWorkFlow.com