Affidavit in Support of Petition to Expunge or Seal

(7/30/04) CCCR 0328

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

STATE OF ILLINOIS
COUNTY OF COOK

ss:

AFFIDAVIT IN SUPPORT OF PETITION TO EXPUNGE OR SEAL

I, _______________________________________________, if sworn to as a witness, can testify competently.

I was arrested on or about ___________________________________ by the ______________________________
Police Department on the charge(s) of ________________________________________________________________.

I appeared in court on this cause and the disposition was _________________________________________________.

My Date of Birth: _________/_________/_________, Sex: _________, Race: _______________________________.

I have been informed by the Office of the Clerk of the Circuit Court of Cook County that the court half sheet
and case file are unavailable.

____________________________________________
(Signature of Petitioner)

VERIFICATION
Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned
certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to
be on information and belief and as to such matters the undersigned certifies as aforesaid that s/he verily believes
the same to be true.

____________________________________________
(Signature of Petitioner)
Atty. No.: _________________

Pro Se 99500

Name: ___________________________________________
Address: _________________________________________
City/State/Zip: ____________________________________
Telephone: ________________________________________
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS