CR-266, 11/15 Petition to Expunge Criminal Court Record of Conviction (Non-Probation/Non-Incarceration) 247973.015, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. UNDER OATH I STATE : 1. I am the person convicted in this criminal case. I am asking that the court record of my criminal convictio n be expunged. I understand that if the record is expunged: only the court record of the convictio n will be expunged; other court records and records of the police, the Crime Information Bu reau, other law enforcement agencies, and the di stric t attorney will not be affected, AND the conviction is not vacated or set aside. 2 . At the time the sentence was imposed, the court ordered that the record be expunged upon successful completion of the sentence . 3. I was not placed on probation. 4. I was not sentenced to jail or prison. 5. I have successfully completed my sentence in this case, including payment of all court - ordered financial obligations. 6. Between the date of conviction in this case and successful completion of my sentence, I was not convicted of another criminal offe nse. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Petitioner Name Printed or Typed Address Address Date DISTRIBUTION: 1. Court 2. Petitioner 3. District Attorney STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Name Date of Birth Petition to Expunge Court Record of Conviction (Non - Probation/ Non - Incarceration) Case No. American LegalNet, Inc. www.FormsWorkFlow.com