Petition For Expungement (For Acquittal, Dismissal With Prejudice, Or Failure To Indict) Form
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1
2NOTE: A SEPARATE PETITION MUST BE FILED FOR EACH CRIMINAL CASE AND THE CHARGE(S) MUST BE
LISTED IN THIS MOTION FOR THE CHARGE(S) TO BE EXPUNGED. ADDITIONALLY, A COPY OF YOUR CURRENT
EXPUNGEMENT CERTIFICATION MUST BE ATTACHED TO THIS PETITION.
AOC-497.2
Doc. Code: PEXA
Rev. 7-16
Case No. ____________________
Page 1 of 2
l e x
e t
Court
____________________
j u s t i t i a
Commonwealth of Kentucky
County
____________________
Court of Justice
PETITION FOR EXPUNGEMENT
Division
____________________
(FOR ACQUITTAL, DISMISSAL WITH PREJUDICE,
KRS 431.076; 431.079
OR FAILURE TO INDICT)
COMMONWEALTH OF KENTUCKY
PLAINTIFF
VS.
________________________________________________ NAME
DEFENDANT
________________________________________________ ADDRESS
________________________________________________
_________________________________PHONE NUMBER
(
)
Defendant’s Birthdate: _____________ Defendant’s SSN: ________________ Violation/Arrest Date: _____________
Jail ID Number____________________________(optional)
Comes now the Defendant herein and petitions the Court, pursuant to KRS 431.076, to expunge the following charges which
were either acquitted, dismissed with prejudice or did not result in indictment in the above-referenced case:
CHARGE: ____________________________________
CHARGE: ___________________________________
CHARGE: ____________________________________
CHARGE: ___________________________________
CHARGE: ____________________________________
CHARGE: ___________________________________
In support of this Petition, the Defendant states as follows: (Check all that apply)
1.
q At least sixty (60) days prior to filing this petition, the Defendant was acquitted of the above-listed charge(s); or,
q At least sixty (60) days prior to filing this petition, the above-referenced charge(s) was/were dismissed with
prejudice and said dismissal was NOT in exchange for a guilty plea to another offense;
q The above listed felony charges originally filed in district court have not resulted in an indictment by the grand
jury and twelve (12) months have elapsed since the date of the District Court decision to hold the matter to the
grand jury.
AND
2.
q There are no current charges or proceedings pending in the above-styled case.
The Defendant prays that this Petition for Expungement for Acquittal, Dismissal with Prejudice, or Failure to Indict be
granted and that this Court enter an Order that the following agencies expunge any records in the agencies' custody
regarding these charges:
LIST AGENCIES AND ADDRESSES HERE:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________________.
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