Application For Expungement Form
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1The State of South Carolina
SOLICITOR’S OFFICE
Dan Johnson
Daniel R. Goldberg
Solicitor
Fifth Judicial Circuit
Deputy Solicitor
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Post Office Box 192
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Paulette Edwards
1701 Main Street
Brett Perry
Deputy Solicitor
Suite 408
Deputy Solicitor
Columbia, South Carolina 29201
Phone: (803) 576-1824
Fax: (803) 576-1629
APPLICATION FOR EXPUNGEMENT
Complete only ONE application when requesting an expungement of multiple offenses. Please request an
expungement with the appropriate Diversion Program if you completed PTI, AEP or TEP.
Full Legal Name: _____________________________________________________________________
Last
First
Middle
Name as it Appears on Warrant/Ticket: (Maiden Name, Alias)
_____________________________________________________________________________________
Last
First
Middle
DOB: _____ - ______ - ______ SSN: ______ - _____ - _______ Race: ______ Sex: _______ Age _____
Current Physical Address: _______________________________________________________________
City
State
Zip
Current Mailing Address: ________________________________________________________________
City
State
Zip
Phone Number: (______) _________-_____________ Alternate: (______) _________-_______________
Law Enforcement Agency:_________________ County: _____________Offense Date:____-____-______
Charge(s): ____________________________________________________________________________
HAVE YOU EVER HAD ANY CHARGE(S) EXPUNGED FROM YOUR RECORD? YES NO
By signature below, I acknowledge my understanding of the following: My application does not guarantee that I
can have a charge(s) removed from my criminal record. Only a thorough review my Criminal Arrest Record will
reveal whether I am eligible. I may apply directly to the Office of the Solicitor or hire an attorney to apply on my
behalf. When applicable, I am responsible for the NON-REFUNDABLE fees associated with my expungement
request: $250.00 administrative fee to the Solicitor’s Office, $25.00 SLED Verification Fee and $35.00 filing fee to
the Clerk of Court.
________________________________________
___________________________________
Applicant’s Signature
Today’s Date
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