IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY CRIMINAL DIVISION MOTION FOR DISMISSAL AND EXPUNGEMENT (A.R.D.)

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1 IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA CASE NO v. MOTION FOR DISMISSAL AND EXPUNGEMENT (A.R.D.) TO THE HONORABLE JUDGES OF THE COURT 1. On, the defendant,, was placed on Accelerated Rehabilitative Disposition ( A.R.D. ) in the above-captioned case for a period of months. 2. The defendant has successfully completed and complied with all of the terms of the A.R.D. agreement. 3. Pursuant to Rules 319 and 320 of the Pennsylvania Rules of Criminal Procedure, the defendant requests that the charges in the above-captioned case be dismissed and that the defendant s arrest record be expunged. 4. The defendant s date of birth is 5. The defendant s social security number is 6. The defendant s mailing address is 7. The defendant s aliases are 8. The Judge who accepted the A.R.D. was the Honorable of the Bucks County Court of Common Pleas located at 55 East Court Street, Doylestown, Pennsylvania The charges for which the defendant was placed onto A.R.D. are Additional charges associated with this case to be expunged are 10. The charges were filed on.

2 11. The arresting officer (affiant) was of the Police Department located at 12. The OTN for the above-captioned case is. WHEREAS, the defendant requests that this Honorable Court dismiss the charges and expunge the defendant s arrest record for the above-captioned case. By signing this document, I certify that the above statements are true and correct. This certification is made subject to penalty under Section 4904(b) of the Pennsylvania Crimes Code regarding false statements. Respectfully submitted, Date

3 IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA CASE NO v. ORDER FOR DISMISSAL AND EXPUNGEMENT (A.R.D.) AND NOW, this day of, 20, the charges in the abovecaptioned case are DISMISSED and it is DIRECTED that the defendant s arrest record is EXPUNGED. As provided by the defendant 1. The defendant s date of birth is 2. The defendant s social security number is 3. The defendant s mailing address is 4. The defendant s aliases are 5. The Judge who accepted the A.R.D. was the Honorable of the Bucks County Court of Common Pleas located at 55 East Court Street, Doylestown, Pennsylvania The charges for which the defendant was placed onto A.R.D. are Additional charges associated with this case to be expunged are 7. The charges were filed on.

4 8. The arresting officer (affiant) was of the Police Department located at. 9. The OTN for the above-captioned case is. 10. The criminal justice agencies upon which certified copies of the order shall be served 1. The Clerk of Court of Bucks County, Criminal Division. 2. The Bucks County District Attorney s Office The Bucks County Department of Adult Probation. The Bucks County Clerk of Courts shall serve a certified copy of this Order on each of the criminal justice agencies identified. Upon receipt of a certified copy of this Order, the identified criminal justice agencies shall (a) expunge and destroy the official and unofficial arrest and other criminal records of the defendant concerning the listed charges; (b) request, insofar as they are able, the return of such records as they have made available to Federal and other Commonwealth agencies and shall destroy such records upon receipt thereof; (c) provide

5 to the defendant an affidavit that such records have been expunged and destroyed, together with any copies of this order in their possession. BY THE COURT J.

6 VERIFICATION I,, verify that the facts set forth in the foregoing are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa.C.S. Subsection 4904, relating to unsworn falsification to authorities. Date

7 IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA CASE NO v. CERTIFICATE OF SERVICE A true and correct copy of the attached Motion was served upon the Bucks County District Attorney s Office on. Date