La. Code Crim. Proc. art. 989
STATE OF LOUISIANA
JUDICIAL DISTRICT FOR THE PARISH OF
______________________________
No.: _____________Division: "_______"
State of Louisiana
vs.
_______________________________________________________
MOTION FOR EXPUNGEMENT
NOW INTO COURT comes mover, who provides the court with the following information in connection with this request:
NAME: ___________________________________________________________
(Last, First, MI)
DOB: ________/______/_______ (MM/DD/YYYY)
GENDER_____ Female _____Male
SSN (last 4 digits):XXX-XX-________
RACE:_________________
DRIVER LIC.#_________________
ARRESTING AGENCY:__________________________________________
SID# (if available):_________________
ARREST NUMBER (ATN):_________________
AGENCY ITEM NO. _________________
Mover is entitled to expunge the record of his arrest/conviction pursuant to Louisiana Code of Criminal Procedure Article 971 et seq. and states the following in support:
_____ YES _____ NO Arrested, but it did not result in conviction
_____ YES _____ NO Convicted of and seeks to expunge a misdemeanor
_____ YES _____ NO Convicted of and seeks to expunge a felony
_____ YES _____ NOConvicted but determined to be factually innocent and entitled to compensation for a wrongful conviction pursuant to the provisions of R.S. 15:572.8.
____ Yes ____ No ARRESTS THAT DID NOT RESULT IN CONVICTION
NO. 1 La. Rev. Stat. Ann.§ _______ : ________
Name of the offense__________________
() Time expired for prosecution__________________
(MM/DD/YYYY)
() Not prosecuted for any offense
arising out of this charge.
() Pre-trial Diversion Program.
() DWI Pre-Trial Diversion Program
and 5 years have elapsed since the
date of arrest.
() Charge dismissed
() Found not guilty/judgment of acquittal
NO. 2 La. Rev. Stat. Ann.§ _______ : ________
Name of the offense __________________
() Time expired for prosecution__________________
(MM/DD/YYYY)
() Not prosecuted for any
offense arising out of this charge.
() Pre-trial Diversion Program.
() Charge dismissed
() Found not guilty/judgment of acquittal
NO. 3 La. Rev. Stat. Ann.§ _______ : ________
Name of the offense __________________
() Time expired for prosecution__________________
(MM/DD/YYYY)
() Not prosecuted for any offense
arising out of this charge.
() Pre-trial Diversion Program.
() Charge dismissed
() Found not guilty/judgment of acquittal
____ Yes ____ NoMISDEMEANOR CONVICTIONS
NO. 1 La. Rev. Stat. Ann. § _______ : ________
Name of the offense_________________
() Conviction set aside/dismissed_____/____/_______
pursuant to C.Cr.P. Art. 894(B)(MM/DD/YYYY)
() More than 5 years have passed
since completion of sentence.
NO. 2 La. Rev. Stat. Ann. § _______ : ________
Name of the offense_________________
() Conviction set aside/dismissed_____/____/_______
pursuant to C.Cr.P. Art. 894(B)(MM/DD/YYYY)
() More than 5 years have passed
since completion of sentence.
____ Yes ____ NoFELONY CONVICTIONS
NO. 1 La. Rev. Stat. Ann.§ _______ : ________
() Conviction set aside/dismissed_____/____/_______
pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)
() More than 10 years have passed
since completion of sentence
() Received a first offender pardon for an eligible offense
NO. 2 La. Rev. Stat. Ann.§ _______ : ________
() Conviction set aside/dismissed_____/____/_______
pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)
() More than 10 years have passed
since completion of sentence
() Received a first offender pardon for an eligible offense
____ Yes ____ NoOPERATING A MOTOR VEHICLE WHILE INTOXICATED CONVICTIONS
Mover has attached the following:
()A copy of the proof from the Department of Public Safety and Corrections, office of motor vehicles, that it has received from the clerk of court a certified copy of the record of the plea, fingerprints of the defendant, and proof of the requirements set forth in C.Cr.P. Art. 556, which shall include the defendant's date of birth, last four digits of social security number, and driver's license number
[] Criminal Background Check from the La. State Police/Parish Sheriff dated within the past 60 days (required).
[] Bill(s) of Information (if any).
[] Minute entry showing final disposition of case (if any).
[] Certification Letter from the District Attorney for fee waiver (if eligible).
[] Certification Letter from the District Attorney verifying that the applicant has no convictions or pending applicable criminal charges in the requisite time periods.
[] Certification Letter from the District Attorney verifying that the charges were refused.
[] Certification Letter from the District Attorney verifying that the applicant did not participate in a pretrial diversion program.
[] A copy of a first offender pardon.
[] A copy of the order waiving the sex offender registration and notification requirements.
[] A copy of the court order determination of factual innocence and order of compensation for a wrongful conviction pursuant to the provisions of R.S. 15:572.8 if applicable.
The Mover prays that if there is no objection timely filed by the arresting law enforcement agency, the district attorney's office, or the Louisiana Bureau of Criminal Identification and Information, that an order be issued herein ordering the expungement of the record of arrest and/or conviction set forth above, including all photographs, fingerprints, disposition, or any other such information, which record shall be confidential and no longer considered a public record, nor be made available to other persons, except a prosecutor, member of a law enforcement agency, or a judge who may request such information in writing, certifying that such request is for the purpose of prosecuting, investigating, or enforcing the criminal law, for the purpose of any other statutorily defined law enforcement or administrative duties, or for the purpose of the requirements of sex offender registration and notification pursuant to the provisions of R.S. 15:541 et seq. or as an order of this Court to any other person for good cause shown, or as otherwise authorized by law.
If an "Affidavit of No Opposition" by each agency named herein is attached hereto and made a part hereof, Defendant requests that no contradictory hearing be required and the Motion be granted ex parte.
Respectfully submitted,
____________________________________
Signature of Attorney for Mover/Defendant
____________________________________
Attorney for Mover/Defendant Name
____________________________________
Attorney's Bar Roll No.
____________________________________
Address
____________________________________
City, State, ZIP Code
____________________________________
Telephone Number
If not represented by counsel:
____________________________________
Signature of Mover/Defendant
____________________________________
Mover/Defendant Name
____________________________________
Address
____________________________________
City, State, ZIP Code
____________________________________
Telephone Number
La. Cr.P. § 989