FEES FOR FILING A PETITION TO SEAL/EXPUNGE $1.35 FEE TO PURCHASE A SEAL/EXPUNGE PACKET

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FEES FOR FILING A PETITION TO SEAL/EXPUNGE $1.35 FEE TO PURCHASE A SEAL/EXPUNGE PACKET At the time of filing the notarized Petition to Seal/Expunge Criminal History Record and the notarized Affidavit, a filing fee of $62.00 shall be paid to the Clerk of Court. Our office includes the charges of $1.00 per page for copies, and $2.00 per page for certification.

STATE OF FLORIDA, Plaintiff, VS. CASE NO: Defendant. PETITION TO SEAL/EXPUNGE CRIMINAL HISTORY RECORD COMES NOW the Defendant,, and petitions this Honorable Court, pursuant to Florida Rule of Criminal Procedure 3.692, and Florida Statute 943.059 to SEAL / EXPUNGE (circle one) all criminal history record information concerning his/her arrest on the day of, 20, by the (arresting agency), for (charges), and as grounds therefore would show by the following sworn statement attesting: 1. That on the day of, 20, the Defendant,, a (race/sex), whose date of birth is, was arrested and charged with. 2. That the Defendant has never previously been adjudicated guilty of a criminal offense or an ordinance having all the essential elements of a statutory misdemeanor or felony. 3. That the defendant has not been adjudicated guilty of any of the charges stemming from the arrest or alleged criminal activity to which this petition pertains. 4. That the Defendant has not secured a prior records expunction or sealing under this Section, former Section 893.14, former Section 901.33, or former Section 943.058, or from any jurisdiction outside the state. 5. That the Defendant is eligible to the best of his or her knowledge or belief and does not have any other petition to seal or petition to expunge pending before any court.

6. That prior to filing this petition, the Defendant has applied to and received from the Department of Law Enforcement, a certificate of eligibility for sealing/expunging. The certificate of eligibility (FDLE Form 40-022) is attached to this petition. WHEREFORE, the Defendant,, moves this Honorable Court to seal /expunge any criminal history record information concerning his/her arrest by (arresting agency) for (charges) on the day of, 20. I HEREBY CERTIFY that a true and correct copy of the foregoing pleading has been served upon William Eddins, State Attorney for the First Judicial Circuit, in and for Walton County, (arresting agency), and the Sheriff of Walton County this day of, 20. Name: Address: City/State/Zip: Phone Number: STATE OF FLORIDA COUNTY OF Walton County Sworn to and subscribed before me this day of, 20. Notary Public My Commission Expires: NOTICE: Any person who knowingly provides false information on this sworn petition commits a felony of the third degree.

State of Florida, Plaintiff Vs. Case #, Defendant/Petitioner State of Florida County of Walton AFFIDAVIT I, am the defendant/petitioner in the above styled cause and I do hereby swear or affirm that: 1. I fully understand the meaning of all of the terms of this affidavit. 2. I have never been adjudicated guilty of a criminal offense or a comparable ordinance violation. 3. I was arrested on the day of,, by (arresting agency), and I have not been adjudicated guilty of the charges stemming from that arrest or the alleged criminal activity surrounding my arrest. 4. I am eligible for the relief requested, to the best of my knowledge and belief, and do not have any other petition to expunge or seal pending before any court. 5. I have never secured a prior records expunction or sealing under any law. 6. (For use in expunction petitions only.) My record of arrest for this date has been sealed for at least 10 years; or an indictment or information was not filed against me for the above criminal transaction; or an indictment or information filed against me was dismissed by the prosecutor or the Court. Petitioner Sworn to and subscribed before me this day of, 20. Notary Public Printed, typed or stamped commissioned name of Notary Public.

STATE OF FLORIDA, Plaintiff, Vs. CASE NO., Defendant/Petitioner. ORDER TO EXPUNGE CRIMINAL HISTORY RECORDS PURSUANT TO FLORIDA STATUTE SECTION 943.0585 AAND FLORIDA RULE OF CRIMINAL PROCEDURE 3.692 THIS CAUSE having come on to be heard before me this date upon a Petition to Expunge certain records of the petitioner s arrest on the day of, 20, by the (arresting agency) for (charges), and the Court having heard argument of counsel and being otherwise advised in the premises, the Court hereby finds the following: 1. The petitioner has never been adjudicated guilty of a criminal offense or comparable ordinance violation. 2. The petitioner was not adjudicated guilty of charges stemming from the arrest or criminal activity to which this expunction petition pertains. 3. The petitioner has not secured a prior records expunction or sealing. 4. This record has been sealed for at least 10 years and/or the indictment or information filed (if any) against the petitioner was dismissed by the prosecutor or the Court. Whereupon it is ORDERED that the Petition to Expunge is granted. All Court records pertaining to the above-styled case shall be expunged in accordance with the procedures set forth in Florida Rules of Criminal Procedure 3.692; and it is further ORDERED that the Clerk of this Court shall forward a certified copy of this Order to the State Attorney (or if applicable, the statewide prosecutor), (arresting agency), and the Sheriff of Walton County, who will comply with the procedures set forth in the authorities cited above and appropriate regulations of the Department of Law Enforcement, and who will further forward a copy of this Order to any agency that their records reflect has received the instant criminal history record information; and it is further

ORDERED that (arresting agency) and the Florida Department of Law Enforcement shall expunge all information concerning indicia of arrest or criminal history record information regarding this petitioner in accordance with the procedures set forth in the authorities cited above. All costs of certified copies involved herein are to be borne by the Petitioner. DONE AND ORDERED in DeFuniak Springs, Walton County, Florida this day of, 20. County Judge / Circuit Judge Copies to: State Attorney Defendant/Petitioner Arresting Agency Sheriff of Walton County Florida Department of Law Enforcement

STATE OF FLORIDA, Plaintiff, Vs. CASE NO. Defendant/Petitioner. ORDER TO SEAL CRIMINAL HISTORY RECORDS PURSUANT TO FLORIDA STATUTE SECTION 943.0585 AND FLORIDA RULE OF CRIMINAL PROCEDURE 3.692 THIS CAUSE having come on to be heard before me this date upon a Petition to Seal certain records of the petitioner s arrest on the day of, 20, by the (arresting agency) for (charges), and the Court having heard argument of the petitioner and being otherwise advised in the premises, the court hereby finds the following: 1. The petitioner has never previously been adjudicated guilty of a criminal offense or comparable ordinance violation. 2. The petitioner was not adjudicated guilty of charges stemming from the arrest or criminal activity to which this Petition to Seal pertains. 3. The petitioner has not secured a prior records expunction or sealing; whereupon it is ORDERED that the clerk of this court shall forward a certified copy of this Order to the State Attorney (or if applicable, the statewide prosecutor), (arresting agency), and the Sheriff of Walton County, who will comply with the procedures set forth in the authorities cited above and appropriate regulations of the Department of Law Enforcement, and who will further forward a copy of this Order to any agency that their records reflect has received the instant criminal history record information; and it is further ORDERED that the clerk of this Court shall forward a certified copy of this Order to the State Attorney (or if applicable, the statewide prosecutor), (arresting agency), and the Sheriff of Walton County, who will comply with the procedures set forth in the authorities cited above and appropriate regulations of the Department of Law Enforcement, and who will further forward a copy of this Order to any agency that their records reflect has received the instant criminal history information; and it is further

ORDERED that the (arresting agency) and the Florida Department of Law Enforcement shall seal all information concerning indicia of arrest or criminal history record information regarding this petitioner in accordance with the procedures set forth in the authorities cited above. All costs of certified copies involved herein are to be borne by the Petitioner. DONE AND ORDERED in DeFuniak Springs, Walton County, Florida, this day of, 20. County Judge / Circuit Judge Copies to: State Attorney Defendant/Petitioner Arresting Agency Sheriff of Walton County Florida Department of Law Enforcement