Louisiana Code of Criminal Procedure Tit. XXXIV, Art. 989. Motion for expungement forms to be used

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.

______________________________

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

______ YES ______ NO

Convicted but determined to be factually innocent and entitled to compensation for a wrongful conviction pursuant to the provisions of R.S. 15:572.8.

4.

Mover was booked and/or charged with the following offenses: (List each offense booked and charged separately. Attach a supplemental sheet, if necessary.)

____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____No

MISDEMEANOR 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____No

FELONY 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____No

OPERATING 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

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 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.

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