Louisiana Code of Criminal Procedure Tit. XXXIV, Art. 994. Motion for interim expungement form to be used

No.:

___________________

Division: “__________”

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 NO. _________________________

    Mover is entitled to an interim expungement of the entry of the felony charge(s) of his arrest pursuant to Louisiana Code of Criminal Procedure Article 985.1 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 for a felony offense.

___ YES ___ NO

Convicted of a misdemeanor arising out of that felony offense.

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

FELONY ARREST THAT RESULTED IN A MISDEMEANOR CONVICTION

NO. 1

La. Rev. Stat. Ann.

§ _______ : _______________

Name of the offense

_____________________

_____________________

(MM/DD/YYYY)

( )

Felony charge dismissed.

( )

Convicted of misdemeanor offense arising out of

felony arrest.

5.

Mover has attached to his Motion a criminal background check from the Louisiana State Police/Parish Sheriff dated within the past sixty days (required).