Missouri > Local Circuit Courts > 21st Circuit (St. Louis County) > Equity
Petition For Expungement Of Arrest Records CCCM70 - Missouri
| Petition For Expungement Of Arrest Records Form. This is a Missouri form and can be used in Equity 21st Circuit (St. Louis County) Local Circuit Courts . |
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,Q WKH &,5&8,7 &2857 For File Stamp Only 2I 6W /RXLV &RXQW\ 0LVVRXUL _____________________________________________ Plaintiff vs. Defendant(s)/ Agency(ies) to be notified: CIRCUIT COURT DIVISION ASSOCIATE COURT DIVISION MUNICIPAL COURT DIVISION DIVISION CASE NUMBER COURT ORI NUMBER Check & Complete all that apply: 02ST. LOUIS COUNTY POLICE DEPT. _____________________________ POLICE DEPT. ___________________________ ___________________________ ___________________________ MISSOURI HIGHWAY PATROL TROOP_________ CRIMINAL RECORDS REPOSITORY PROSECUTOR'S OFFICE (INCLUDE NAME OF COUNTY OR CITY) OF: ST. LOUIS COUNTY PROSECUTOR'S CITY/ VILLAGE OF_________________________ PROSECUTOR'S OTHER (INCLUDE NAME AND LOCATION OF AGENCY) ______________________________________________ ______________________________________________ 3(7,7,21 )25 (;381*(0(17 2) $55(67 5(&25'6 Pursuant to Section 610.122, RSMo, I request that the court issue an order to expunge my record of arrest, for the criminal case described below: I am filing this petition in the county where the arrest occurred and I hereby swear that I have no prior or subsequent misdemeanor or felony convictions and I did not receive a suspended imposition of sentence (SIS) for the offense for which the arrest was made or for any offense related to the arrest. I also state that the arrest was based on false information, there is no probable cause at the time of the action to expunge to believe that I committed the offense and no charges will be pursued as a result of the arrest, and no civil action is pending relating to the arrest or the records sought to be expunged. Pursuant to Section 610.123, RSMo, I have attached the petitioner's fingerprints on a standard fingerprint card, and I have reason to believe the agencies named above as defendants may possess records subject to expungement. FULL NAME DATE OF BIRTH SOCIAL SECURITY NUMBER SEX M F RACE DRIVER'S LICENSE NUMBER ADDRESS AT TIME OF ARREST OFFENSE CHARGED DATE OF ARREST ARREST CITATION NUMBER IF CRIMINAL CHARGES WERE FILED, DATE OF DISMISSAL OR REVERSAL NAME OF ARRESTING AGENCY COUNTY WHERE PETITIONER WAS ARRESTED (IF ARREST OCCURRED IN A MUNICIPALITY, ALSO NAME MUNICIPALITY) CASE NUMBER AND DIVISION OF COURT OF THE OFFENSE CIRCUIT ASSOCIATE MUNICIPAL DIVISION__________ #________________________________________________________________ NOT APPLICABLE I, plaintiff, swear the facts stated in the above petition are true according to my best knowledge and belief. ______________________________________________________ Plaintiff's Signature is required / Address _________________________________________________________ _________________________________________________________ Attorney for Petitioner MBE# Subscribed and sworn to before me this____________ day of ____________________________, _______________. __________________________________________________ Notary Public/ Judge/ Clerk My Commission expires: __________________ __________________________________________________________; ____________________________________________________ Address CCCM70 Rev. 08/03 WHITE - File YELLOW - Agency 1 PINK - Agency 2 GOLDENROD - Petitioner American LegalNet, Inc. www.FormsWorkFlow.com
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