Application For Expungement Form
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1IN THE COURT OF COMMON PLEAS OF DEFIANCE COUNTY, OHIO
JUVENILE DIVISION
EXPUNGEMENT APPLICATION
(O.R.C. 2151.358)
Please Print
Name ________________________________________________________________
Last
First
M.I.
(Applicant should list name when the juvenile record was obtained, even if different now)
Date of Birth_______ Current Age _____ Social Security Number ____- ___ - ____
Address________________________________________________________________
City _________________ State _______ Zip ______ Ph.( _____) - ______ - ________
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
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Case number(s) requested to be expunged: (
The Juvenile Court clerk will help you if you do not know the
)
case numbers
________________________________________________________________________
________________________________________________________________________
The undersigned applicant hereby requests that the applicant’s record be expunged.
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:
_______________________________________________________________________
_______________________________________________________________________
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.
Applicant’ s Signature ______________________________ Date ________________
Application to expunge record ORC 2151.358
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