Petition To Seal Mip (Marijuana & Alcohol) Record Form printable pdf download

Petition To Seal Mip (Marijuana & Alcohol) Record Form

Municipal Court, City of Boulder, Colorado

1777 6

St.

P.O. Box 8015

Boulder CO 80306

___________________________________________________________________________________________

COURT USE ONLY

The People of the City of Boulder, by and on behalf of, the People of

the State of Colorado

Case Number:

________________________________________

Defendant:

PETITION TO SEAL PURSUANT TO §5-7-4(f) OR §5-10-4(d) B.R.C

I, ____________________________________________________ (Name of Defendant), petition the

court to seal my conviction under §5-7-4(f), B.R.C. (illegal possession or consumption of alcohol) or §5-

10-4(d), B.R.C. (illegal possession or consumption of marijuana by a minor).

1. Information about the Defendant: *If this information is not given, petition will not be processed*

DOB: ________________

Current Mailing Address: _______________________________________________________

City, State, and Zip Code: ______________________________________________________

Home Phone #: _____________ Work Phone #: _______________

Cell #: ______________

2. I request that the following information be sealed:

Date of Violation

Name of Law Enforcement Agency

Case Number

I successfully completed the terms of my deferred prosecution, OR, conviction was entered by the

court and I have not been arrested for, charged with, or convicted of any felony, misdemeanor, petty

offense, or municipal ordinance violation during the period of one year following the date of the above

conviction, OR, my case was dismissed by the prosecution, OR I was found not guilty at trial.

I swear or affirm that I have read the foregoing Petition and that the statements contained in this

Petition are true to the best of my knowledge and belief.

_______________________________________

______________________________________

Signature of Attorney (if applicable)

Date

Signature of Defendant

Date

Attorney’s Name, Address, Phone & Fax:

(If applicable)

Petition To Seal Mip (Marijuana & Alcohol) Record Form