Petition For Expungement (For Acquittal, Dismissal With Prejudice, Or Failure To Indict) Form Page 2

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County
AOC-497.2
Case No
Rev. 7-16
. _________________________
Page 2 of 2
Note: Defendant/Movant must sign this petition in the presence of a notary or the circuit court clerk so that the
clerk can witness his/her signature.
Date: _____________________, _______.
___________________________________________
Defendant/Petitioner Signature
Print Form
Reset Form
Subscribed and sworn to before me by ________________________________________________________________
this _______ day of ______________________, _______.
____________________________________________
Notary/Clerk
My commission expires: ___________________, _______
By: ____________________________________ D.C.
ORDER
Having considered this Petition for Expungement:
q the court hereby orders the circuit court clerk to set a date for an expungement hearing.
q no hearing is required.
____________________________________________
Judge
NOTIFICATION OF EXPUNGEMENT HEARING
This case is set for a hearing on ________________________________, ______ at the hour of ____________
q a.m. q p.m. at the ________________________________ q District q Circuit Court. Dated this ________ day
of ________________________________, _________. The County or Commonwealth's attorney, as appropriate, may
respond to this Petition. If the criminal charge(s) relates to the abuse or neglect of a child, the Office of General Counsel
of the Cabinet for Health and Family Services (CHFS) shall respond within twenty (20) days of receipt of this notification
if the CHFS has custody of records that reflect that Defendant/Petitioner has been determined by the CHFS or by a court
under KRS Chapter 620 to be a substantiated perpetrator of child abuse or neglect.
_____________________________________________
Clerk
By: ______________________________________D.C.
For Clerk Use Only
If the court ordered an expungement hearing, this Petition for Expungement was sent on the ________ day of
_____________________________, _____ to Defendant/Petitioner or his/her Attorney; the County or Commonwealth's
Attorney, as appropriate; and, if the criminal charge(s) relates to the abuse or neglect of a child, to the CHFS. If the court
did not order a hearing, this Petition was sent on the ____ day of _________________________, _____, to Defendant/
Petitioner.
____________________________________________
Clerk
By: ______________________________________D.C.

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