SUPERIOR COURT OF NEW JERSEY LAW DIVISION-CAMDEN COUNTY
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1 NAME: STREET: CITY: STATE: ZIP: SOCIAL SECURITY NO: SUPERIOR COURT OF NEW JERSEY LAW DIVISION-CAMDEN COUNTY DOCKET NO: CIVIL ACTION PETITION FOR EXPUNGEMENT IN THE MATTER OF THE EXPUNGEMENT OF THE CRIMINAL RECORD OF: I, residing at (YOUR ADDRESS) 1. My date of birth is 2. I was arrested on in and charged with 3. The original COMPLAINT number was/were 4. On, the charges were amended/downgraded/remanded to 5. On the charge of was dismissed. 6. On I was found guilty of the charge of
2 8. I was arrested on in and charged with 9. The original COMPLAINT number was/were 10. On, the charges were amended/downgraded/remanded to 11. On the charge of was dismissed. 12. On I was found guilty of the charge of 13. I was arrested on in and charged with 14. The original COMPLAINT number was/were 15. On, the charges were amended/downgraded/remanded to 16. On the charge of was dismissed. 17. On I was found guilty of the charge of
3 18. I was arrested on in and charged with 19. The original COMPLAINT number was/were 20. On, the charges were amended/downgraded/remanded to 21. On the charge of was dismissed. 22. On I was found guilty of the charge of 23. I was arrested on in and charged with 24. The original COMPLAINT number was/were 25. On, the charges were amended/downgraded/remanded to 26. On the charge of was dismissed. 27. On I was found guilty of the charge of
4 28. I was arrested on in and charged with 29. The original COMPLAINT number was/were 30. On, the charges were amended/downgraded/remanded to 31. On the charge of was dismissed. 32. On I was found guilty of the charge of 33. I was arrested on in and charged with 34. The original COMPLAINT number was/were 35. On, the charges were amended/downgraded/remanded to 36. On the charge of was dismissed. 37. On I was found guilty of the charge of
5 38. I was arrested on in and charged with 39. The original COMPLAINT number was/were 40. On, the charges were amended/downgraded/remanded to 41. On the charge of was dismissed. 42. On I was found guilty of the charge of I requested that this Court grant me an Order of Expungement authorized by N.J.S.A. 2C:52-1 et seq. directing the clerk of the court and all relevant criminal justice and law enforcement services of the State of New Jersey to expunge from their records all evidence of the arrest and proceedings in this matter, and further directing any New Jersey Law Enforcement and request the return of the records. PETITIONER S SIGNATURE
6 VERIFICATION of full age, being duly sworn according to law, upon oath deposes and says: 1. I am the petitioner in the matter and statements made in this Petition are true to the best of my knowledge. 2. There are no disorderly person, petty disorderly persons or indictable charges pending against me at this time. 3. If I am seeking expungement of a conviction on a criminal charge, I have never been granted an expungement of an indictable conviction by any State of Federal Court. PETITIONER S SIGNATURE Sworn to and subscribed Before me this Day of, 20 NOTARY PUBLIC
7 NAME: STREET: TOWN: PHONE: SUPERIOR COURT OF NEW JERSEY LAW DIVISION-CAMDEN COUNTY IN THE MATTER OF THE EXPUNGEMENT OF THE CRIMINAL RECORD OF: DOCKET NO: CIVIL ACTION ORDER FOR HEARING This matter having been opened to the Court upon the annexed Petition of and for good cause appearing, It is ordered this day of 20, That a hearing before this court is set for day of 20, at 9:00 o clock in the forenoon to determine whether an Order for Expungement shall be granted; It is further ordered that a petitioner shall send by CERTIFIED MAIL, RETURN RECEIPT REQUESTED, Copies of this Order and Petition, to the following officials within (5) days of this order: The Superintendent of the New Jersey State Police The Attorney General of New Jersey The Prosecutor of Camden County The Municipal Judge of the Municipal Court The Chief of Police of the Municipality The Camden County Probation Department (if probation was served) Camden County Family Division (if contacted) The Honorable Michele M. Fox, JSC
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