Free Commonwealth of Pennsylvania - Pennsylvania

Commonwealth of Pennsylvania v.

: : :

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY, PENNSYLVANIA Criminal Division PP#: OTN#: D.C.#: M.C. Docket #: C.P. Docket # (if applicable): D.O.B.: SID#: ORDER

And now, this

day of

it is ORDERED that the criminal charges in the above-captioned ) and the defendant's arrest record regarding these charges

case specified below are (the disposition is shall be expunged. 1. Defendant's name: Date of Birth: Social Security #: 2. The charges to be expunged are: Description of Charges

Code Section

Disposition

Date Disposed

3. This arrest was made by the Philadelphia Police Department on should be expunged because:

. The arrest record

4. The following criminal justice agencies shall be served with certified copies of this Order: a. Philadelphia Police Department, Expungement Unit b. PA State Police, Central Record. Further, it is ORDERED that the arresting agency shall destroy or deliver to defendant or representative all criminal records, fingerprints, photographic plates and photographs pertaining to the charge(s) specified above, which resulted from the arrest(s) of . Moreover, the Pennsylvania State Police shall request

the Federal Bureau of Investigation to return to them all records pertaining to said arrest(s), which shall be destroyed by said agency upon their receipt of same. Lastly, the Administrative Office of Pennsylvania Courts shall remove the arrest record from the CPCMS computer indexes. BY THE COURT: ________________________
01-208

Commonwealth of Pennsylvania v.

: : :

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY, PENNSYLVANIA Criminal Division PP#: OTN#: D.C.#: M.C. Docket #: C.P. Docket # (if applicable): D.O.B.: SID#:

PETITION TO EXPUNGE CRIMINAL RECORD TO THE HONORABLE JUDGES OF SAID COURT: Petitioner, 1. Petitioner lives at respectfully represents: and is years old; date of birth is

2. Petitioner was arrested by the Philadelphia Police Department on, and charged with 3. On , the outcome of the case is

4. As a result of this arrest and subsequent photographing and fingerprinting, petitioner has been caused to suffer loss of employment opportunities, embarrassment and irreparable harm. 5. The Commonwealth or Pennsylvania will not be harmed by granting this petition. WHEREFORE, your petitioner prays that the Court direct the Commissioner of the Philadelphia Police Department and the Commissioner of the Pennsylvania State Police to expunge the fingerprints, photographs and records of arrest of petitioner from the files of their respective Police Departments and deliver the same to your petitioner or their attorney, or in lieu thereof, proof that said data has been destroyed and that they request that the Federal Bureau of Investigation return all records pertaining to the same arrest for destruction by the Philadelphia Police Department or by petitioner, and further, that the Administrative Office of Pennsylvania Courts (AOPC) in Mechanicsburg, Pennsylvania have the same records removed from computer indexes maintained by the AOPC. RESPECTFULLY SUBMITTED,

___________________________ Petitioner's Signature

01-208 (2)

Commonwealth of Pennsylvania v.

: : :

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY, PENNSYLVANIA Criminal Division PP#: OTN#: D.C.#: M.C. Docket #: C.P. Docket # (if applicable): D.O.B.: SID#: AFFIDAVIT

, being duly sworn according to law, disposes and says that the facts set in the foregoing petition are true and correct to the best of my knowledge, information and belief.

_____________________________ Petitioner's Signature

SWORN TO AND SUBSCRIBED Before me this day of ,

_______________________________ NOTARY PUBLIC:

01-208 (3)