Application to Seal Arrest Record

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CITY OF CLEVELAND,
Plaintiff

-vs-

Defendant

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CASE NO. a

CASE NO. b

CASE NO. c

JUDGE

APPLICATION TO SEAL RECORD AFTER NOT GUILTY OR DISMISSAL

Applicant hereby makes an application to the Court pursuant to Section 2953.52 of the Ohio Revised Code for an order sealing the official records after a not guilty finding or a dismissal of the proceedings in this case.

Applicant hereby provides the following information:

1. a. Original Charge:

1. b. Original Charge:

1. c. Original Charge:

2. Date of Arrest
or Incident:

a. Month

b. Day

c. Year

3. Date of Not Guilty Finding or Dismissal:

4. Applicant Current Address:

5. Applicant Phone #

6. Applicant SSN:

DOB:

7. Applicant Email Address:

Applicant states that he/she was found not guilty in this case or the case was dismissed; that he/she has no criminal proceedings pending; and that the interests of applicant in having the records pertaining to this case sealed are not outweighed by any legitimate governmental needs to maintain those records.

Respectfully submitted,

Name (Please print)

Signature / print name /

Certificate of Service

A copy of the foregoing has been sent via regular, U.S. Mail, postage prepaid on

this:

Month

Day

Year

to the Prosecuting Attorney for the City of Cleveland.

Signature of Defendant / print name /