Free Document1 - Pennsylvania

REQUEST FOR EXPUNGEMENT
MDJ# Docket# Defendant Name OTN# COURT ORDER#

Please check the following prior to mailing to AOPC:
Has the court order been signed? Is a copy of the court order enclosed? Is this a partial expungement? Yes No

Specify charges to be expunged as indicated on the court order. Specify charges that should remain as indicated on the court order.

Is there on defendant specified on the court order for expungement while others should remain on the case? Yes No What is the name of the defendant to be expunged? Which defendant(s) shall remain on the case? Case was archived and has been restored.

AOPC Use Only
Lawyer Defendant Clerk of Courts Case expunged Prev expunged Other Tape ID not found Multiple expunged Def & doc# differ

Case not in auto system Incomplete documentation Not submitted in a timely manner

AOPC 101-05