Expunction Sheet

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EXPUNCTION OR 30 DAY ACQUITTAL CASE INFORMATION SHEET

• Is this a “30 DAY” acquittal expunction: ______YES _____NO

• COURT hearing the original case(s) to be expunged or sealed:

Justice of the Peace: ________ Case#_________________________

County Court: _____________ Case#_________________________

District Court: _____________ Case#_________________________

Municipal Court: ____________ Case#_________________________

Other: _____________________ Case#_________________________

No Billed (i.e. charges dropped) ___________YES ____________NO

Form Completed By:

Name: _________________________

Phone # ________________________

Revised 3-27-2018

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