Approved, SCAO
Original - Court 1st copy - State Police 2nd copy - Arresting agency
3rd copy - Prosecuting official 4th copy - Defendant
STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT
ORI
CASE NO. ORDER ON APPLICATION TO SET ASIDE CONVICTION
Court telephone no.
Court address
MIPolice Report No.
The State of Michigan THE PEOPLE OF v
Defendant's name, address, and telephone no.
CTN/TCN Date of Offense
SID Charge
DOB
Instructions: An order may not be entered until receipt of the report of the Michigan State Police. Copies of the order must be sent to the Michigan State Police and the prosecuting official.
THE COURT FINDS: 1. The Michigan State Police has reported to the court required information from the department's records. 2. The applicant has not been convicted of more than one criminal offense. 3. The conviction is not a traffic offense or a felony for which the maximum punishment is life imprisonment. 4. It has been at least five years since the sentence was imposed or since the defendant was discharged from imprisonment for the conviction. 5. An opportunity has been given to the Attorney General and prosecuting official to contest the application. 6. Circumstances and behavior of the applicant justify setting aside the conviction, and it is consistent with the public welfare. IT IS ORDERED: (If any item from 1 through 6 is not checked, then item 7 must be checked.) 7. The application is denied. 8. The conviction in this case is set aside. Under MCL 780.623 the court clerk, the arresting agency, and the Michigan State Police shall maintain a nonpublic record of the order setting aside conviction and of the arrest, fingerprints, conviction, and sentence in this case. If the conviction is for a nontraffic offense that was reportable to the Secretary of State in accordance with MCL 257.732(20), the driving record shall not be expunged.
Date
Judge
Bar no.
NOTE: Pursuant to MCL 780.622, if this order sets aside a conviction for a listed offense as defined in MCL 28.722 of the Sex Offenders Registration Act, you are still considered to have been convicted of that offense and you must comply with the registration and reporting requirements of the act.
Pursuant to MCL 769.16a the clerk of the court shall advise the Michigan State Police Criminal Justice Information Center of the disposition.
MC 228 (3/08)
ORDER ON APPLICATION TO SET ASIDE CONVICTION
MCL 780.621, MCL 780.623