Request To Expunge Arrest Record- City Of Albany (Page 2 of 3) in pdf

Request To Expunge Arrest Record- City Of Albany Page 2

prosecuting attorney dismisses the charges without seeking an indictment or filing an

accusation may request the original agency in writing to expunge the records of such

arrest. . . .”

SECTION (2)—ARREST INFORMATION (to be completed by the arresting agency)

Date Request Received ____________________________________________________

Original (Arresting) Agency ________________________________________________

ORI Number ____________________________________________________________

Case/Citation/Docket Number ______________________________________________

Date of Arrest ___________________________________________________________

Arrest Charges __________________________________________________________

_______________________________________________________________________

Disposition of Arrest ______________________________________________________

________________________________________________________________________

Prosecuting Attorney/Court Case Referred To __________________________________

________________________________________________________________________

Applicant’s State Identification Number (SID) _________________________________

Does Applicant’s GCIC Criminal History Record Indicate the Disposition of Arrest? If

none appears, a copy of final disposition or completed OBTS form MUST be attached to

this request.

________________________________________________________________________

Signature of Official Completing Form

GCIC Record Expungement Form

Rev 3/2006

Request To Expunge Arrest Record- City Of Albany Page 2