Looking for a Indiana Legal Forms And Templates? Download it for free!

Form # Tcm-35388-1 - Verified Petition Under I.c. 35-38-8 To Restrict Access To Criminal History Records Page 2

NAME

ADDRESS

_______________________

_________________________________________

________________________

_________________________________________

________________________

_________________________________________

________________________

_________________________________________

7. That petitioner is not a sex or violent offender.

8. That petitioner’s date of birth is _________, and the last 4 digits of petitioner’s Social

Security Number are ________.

WHEREFORE, Petitioner requests the Court to order the Indiana State Police

Department, each of the entities or persons listed in paragraph 6 of this petition, and any state,

regional or local central repository for criminal history information to prohibit the release of

petitioner’s records or information relating to the misdemeanor or nonviolent Class D felony

described in this petition to any noncriminal justice agency without a court order.

VERIFICATION

I affirm, under the penalties for perjury, that the foregoing representations are true.

(signed) ______________________________

______________________________

Print your name

_______________________________

Mailing Address

_______________________________

Town, State and Zip Code

_______________________________

Telephone number, with area code

Form # TCM‐35388‐1 Approved by State Court

Administration (08/11)

Form # Tcm-35388-1 - Verified Petition Under I.c. 35-38-8 To Restrict Access To Criminal History Records Page 2