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      CCRP 989     

  

Art. 989. Motion for expungement forms to be used

 

            "                                    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:

I.DEFENDANT INFORMATION

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 NUMBER:             _________________

            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:

II.ARREST INFORMATION

            1.         Mover was arrested on _______/______/_______ (MM/DD/YYYY)


 

            2.         _____ YES _____ NO           A supplemental sheet with arrests and/or convictions is attached after page 2 of this Motion.

 

3.Mover was:

 

_____ 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

 

            4.         Mover was booked and/or charged with the following offenses: (List each offense booked and charged separately. Please number each item numerically beginning with number 1. Attach a supplemental sheet, if necessary.)

 

            ____ Yes ____ No    ARRESTS THAT DID NOT RESULT IN CONVICTION

 

            ITEM NO.                 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

 

            ITEM NO.                 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

            ITEM NO.                 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 ____ No    MISDEMEANOR CONVICTIONS

 

            ITEM NO.                 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.


 

            ITEM NO.                 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 ____ No    FELONY CONVICTIONS

 

            ITEM NO.                 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

 

            ITEM NO.                 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

 

            ____ Yes ____ No     OPERATING A MOTOR VEHICLE WHILE INTOXICATED CONVICTIONS

 

Mover has attached the following:

 

                        ( )       A certified letter of compliance in accordance with C.Cr.P. Art. 984 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

 

5. Mover has attached to this Motion the following pertinent documents:

 

                                  Criminal Background Check from the La. State Police/Parish Sheriff dated within the past 30 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 the order waiving the sex offender registration and notification requirements.


 

6.Mover was:

 

_____ YES _____ NO Arrested with another individual.


            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 Investigation 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                                       "


            Acts 2014, No. 145, §1; Acts 2015, No. 200, §1.



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