Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County of

District Court
Judicial District: Court File Number: Case Type:

Select County

Criminal

State of Minnesota, Plaintiff vs.

Notice of Hearing and Petition for Expungement (Sealed Records) Minn. Stat. § 609A.03 Or Inherent Authority

Defendant/Petitioner

Notice of Hearing

Notice To Law Enforcement/Prosecutor: Any objection to expungement in this case shall be filed with the court as soon as possible, and within 60 days. This matter is scheduled for hearing on (date) at (time); at (location).

Petition for Expungement
1. I state under oath that I am petitioning the court for expungement (sealing) of a criminal record. 2. My full name, and all other legal names or aliases I have been known as, are:

3. My date of birth is:

EXP102

State

ENG

Rev 8/06

www.mncourts.gov/forms

Page 1 of 3

4. The following are all of the addresses I have lived at since the date of the offense for which I am seeking expungement: (street address, city, state)

5. I am seeking expungement because (Include whether expungement is sought for employment or licensure purposes, the statutory or other legal authority under which expungement is sought, and state in detail and with specifics why expungement should be granted. Attach additional pages if necessary.):

6. My criminal record including all charges, convictions, stays of adjudication or imposition of sentence and pending actions for misdemeanors, gross misdemeanors or felonies in this state, another state, federal court, or a foreign country, whether the conviction occurred before or after the offense for which expungement is sought, consists of:
Case# County-State Type of Charge Date of Offense Conviction (Y/N) Date (If Yes)

7. I have no criminal records, other than listed at #6, in this state or elsewhere. 8. All prior requests for expungement, pardon or sealing of a criminal record, whether for this offense or for any other offense, whether granted or not, that I have made include:

EXP102

State

ENG

Rev 8/06

www.mncourts.gov/forms

Page 2 of 3

9. I qualify for an expungement because: A criminal case against me for a controlled substance violation has been dismissed and the proceedings have been discharged (use Order Sealing Record/Conviction); I was certified or referenced for prosecution as an adult for a crime I committed when I was a juvenile (use Order Sealing Record/Conviction); A criminal matter was resolved in my favor (use Order Concerning Sealing of Records/No Conviction); I was convicted but I have rehabilitated myself. The benefit to me outweighs the disadvantage to the public and the burden on the court (use Order Sealing Record/Conviction). 10. The details of the offense I want to expunge are: Case #_____________Jurisdiction/City

where the offense occurred:_______________________________________________Type of Offense:_______________________________________Date of Offense:__________________ This was a conviction or a dismissal. Date of conviction or dismissal:________________

11. The names of the victims in this case are: Or, there were no identifiable victims.

12. There is is not a current or prior order for protection, restraining order or other nocontact order prohibiting me from contacting the victims (attach copies of any orders to petition). 13. Since conviction of this offense, I have taken the following steps toward personal rehabilitation, including treatment, work, or other personal history (Attach additional pages if necessary.):

Or,
Dated

there was no conviction for this offense.
Signature (Sign only in front of notary public or court administrator.)

Sworn/affirmed before me this

Name:_________________________________

____________day of ___________, Address:_______________________________ _______________.
Notary Public \ Deputy Court Administrator

City/State:______________________________

_____________________________ Zip Code:______________________________ Telephone:_____________________________

EXP102

State

ENG

Rev 8/06

www.mncourts.gov/forms

Page 3 of 3