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Application For Sealing And Expungement Of Juvenile Records - Belmont County Court Of Commom Pleas Page 2

IN THE COURT OF COMMOM PLEAS

JUVENILE COURT DIVISION

BELMONT COUNTY, OHIO

In Re: __________________________________

Case # _________________

(

Alleged _________________________ Child.

List all Case Numbers requested)

SEALING APPLICATION

(O.R.C. 2151.356)

EXPUNGEMENT APPLICATION

(O.R.C. 2151.358)

Juvenile’s Name ________________________________________________________________

Last

First

M.I.

(Applicant should list name when the juvenile record was obtained even if name is different now)

Date of Birth: ___/___/___Current Age ____ Social Security Number #_____________________

Current Address_________________________________________________________________

City, State, Zip Code ___________________________________ Phone:(___) - ____ - ________

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Has the record(s) already been sealed? Yes____ No____

(A record that has been sealed by the Court will automatically be expunged 5 years after it is sealed or at age 23, whichever is earlier)

The undersigned applicant

hereby requests that the applicant’s record be:

Sealed

Expunged

The applicant further states that the applicant is not currently under the jurisdiction of the court in

relation to a delinquency complaint and that at least six months have passed since the termination

of any order made by the Court in relation to the case, or any unconditional discharge from any

institution or facility if the applicant was committed to an institution or facility in relation to the case.

The applicant also authorizes the release of any school and/or police report that may aid the court

in making a finding in this matter.

The applicant further states that the record should be expunged earlier than the time period for

automatic expungement set out in ORC 2151.356 for the following reasons:

______________________________________________________________________________

Applicant’ s Signature ________________________________ Date __________________

Application For Sealing And Expungement Of Juvenile Records - Belmont County Court Of Commom Pleas Page 2