SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT STATE OF WASHINGTON v. Respondent. D.O.B.: No: Motion and Declaration to Seal Records of Juvenile Offender (MTAF) I. Motion RESPONDENT moves the court for an order sealing his or her juvenile court records. This motion is based on RCW Title 13.50.260 or GR 15(c) and the declaration of respondent. Dated: Attorney for Respondent/WSBA No. II. Declaration of Respondent I, 2.1. , state as follows: Finding of guilt: On _____________________ [date] I was found guilty of __________________________________________________________________________ ____________________________________________________________ [name of offense]. 2.2 Sealing records - factors pursuant to RCW Title 13.50.260: Class A Felony Conviction: At least one of the offenses I am attempting to seal involves a Class "A" felony but both of the following are true: (1) Since my last date of release from confinement, including full-time residential treatment, or from the entry of disposition (including deferred disposition), I have spent five consecutive years in the community without committing any offense or crime that has resulted in conviction or adjudication. (2) I have not been convicted of Rape in the First Degree, Rape in the Second Degree, or Indecent Liberties with Forcible Compulstion; All Class B and C Felony, Gross Misdemeanor, or Misdemeanor Convictions, or Diversions: Since my last date of release from confinement, including full-time residential treatment, or from the entry of disposition (including deferred disposition), I MT AND DECL TO SEAL RECORDS (MTAF) ­ Page 1 of 2 WPF JU 10.0300 (07/2015) ­ Laws of 2014, Ch. 175, § 4, GR 15 American LegalNet, Inc. www.FormsWorkFlow.com have spent two consecutive years in the community without committing any offense or crime that has resulted in conviction or diversion. And, I meet the following requirements: There are no proceedings pending against me seeking the conviction or diversion of a juvenile or criminal offense. I am no longer required to register as a sex offender under RCW 9A.44.130 or I have been relieved of the duty to register under RCW 9A.44.143 if I was convicted of a sex offense. I have paid the full amount of restitution owing to the individual victim named in the restitution order, excluding restitution owed to any insurance provider authorized under Title 48 RCW. I am eligible to have my records sealed under RCW Title 13.50 in that I have satisfied all the requirements of those statutes. 2.3 Sealing records of vacated deferred disposition ­ factors pursuant to RCW Title 13.50: I meet the following requirements: The court vacated my deferred disposition and dismissed the case with prejudice pursuant to RCW 13.40.127(9) prior to June 7, 2012. I am over 18 years of age. I have paid the full amount of restitution owing to the individual victim named in the restitution order, excluding restitution owed to any insurance provider authorized under Title 48 RCW. 2.4 Other circumstances that I believe require sealing of my juvenile court records (GR 15): I declare under penalty of perjury under the laws of the state of Washington that the foregoing is, to the best of my knowledge, true and correct. Signed on ______________________, at ______________________________, Washington. ______________________________________ Respondent ______________________________________ Address ______________________________________ MT AND DECL TO SEAL RECORDS (MTAF) ­ Page 2 of 2 WPF JU 10.0300 (07/2015) ­ Laws of 2014, Ch. 175, § 4, GR 15 American LegalNet, Inc. www.FormsWorkFlow.com