Request To Expunge Arrest Record- City Of Albany printable pdf download

Request To Expunge Arrest Record- City Of Albany

REQUEST TO EXPUNGE

ARREST RECORD

O.C.G.A. 35-3-37(d)

SECTION (1) ONE—APPLICANT INFORMATION (to be completed by requester)

PHONE NUMBER WHERE YOU MAY BE REACHED (_ _ _)-_ _ _-_ _ _ _

Name __________________________________________________________________

Date of Birth____________________________ Race _______________ Sex _______

Social Security Number ___________________________________________________

Street Address ___________________________________________________________

________________________________________________________________________

City ___________________________________ State ______________ Zip ________

Arresting Agency ________________________________________________________

Date of Arrest ___________________________________________________________

Offenses Arrested For: ____________________________________________________

________________________________________________________________________

I request that the arrest record information described above pertaining to me be expunged

from the record(s) of the arresting agency pursuant to the provisions of O.C.G.A. 35-3-

37(d).

Signature _______________________________________________________________

Date __________________________

O.C.G.A. 35-3-37(d)(1) provides in part that “An individual who was (A) Arrested for an

offense under the laws of this state but subsequent to such arrest is released by the

arresting agency without such offense being referred to the prosecuting attorney for

prosecution; or (B) After such offense referred to the proper prosecuting attorney, and the

GCIC Record Expungement Form

Rev 3/2006

Request To Expunge Arrest Record- City Of Albany