Petition to Expunge and Impound Criminal Records
(01/20/17) CCCR 0330 A
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
No. _______________________________________________
PEOPLE OF THE STATE OF ILLINOIS
or
_______________________________________________
_________________________________________________
_______________________________________________
A Municipal Corporation
v.
_______________________________________________
_______________________________________________
___________________________________________________
Defendant/Petitioner
Date of Birth: ___________________
Gender: Male Female
Race: _________________________
PETITION TO EXPUNGE AND IMPOUND CRIMINAL RECORDS - FEE REQUIRED
Th e above-named Petitioner states under oath that:
1. Th e Petitioner was arrested and/or charged on the date(s) and for the off ense(s) stated below:
Case Number(s)
Arresting
Charge(s)
Date(s) of
SID/IR/DCN/CB
Disposition
Agency(ies)
Arrest
Additional cases listed on attached page.
Petitioner’s Address: _______________________________________________________________________
_______________________________________________________________________________________
2. Each arrest or charge not initiated by arrest, other than a minor traffi c off ense resulted in
a. an order of supervision was successfully completed for an off ense that is subject to expungement and
the requisite time period has elapsed.
b. an order of qualifi ed probation was successfully completed for an off ense that is subject to expunge-
ment and the requisite time period has elapsed and the Petitioner has attached proof to this Petition
that s/he has passed a drug test taken within 30 days before the fi ling of this Petition showing the
absence within his or her body of all illegal substances; and/or
c. Th e Petitioner was granted a pardon by the Governor which specifi cally authorizes expungement.
3. Th e Petitioner does not have pending charges against him/her.
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 1 of 2