THE MOTION IS HEREBY GRANTED for Item(s) No. ____________ and all agencies are
ordered to expunge the record of arrest/conviction and any photographs, fingerprints, or any other such
information of any kind maintained in connection with the Arrest(s)/Conviction(s) in the above captioned
matter, which record shall be confidential and no longer considered a public record, nor be available to
other persons except a prosecutor, member of a law enforcement agency, or a judge who may request such
information in writing certifying that such request is for the purpose of prosecuting, investigating, or
enforcing the criminal law, for the purpose of any other statutorily defined law enforcement or
administrative duties, or for the purpose of the requirements of sex offender registration and notification
pursuant to the provisions of R.S. 15:541, et seq. or upon an order of this Court to any other person for
good cause shown, or as otherwise authorized by law.
____________________
NAME: ______________________ ____________________________
(Last Name)
(First Name)
(MI)
DOB: ______/_____/______ (MM/DD/YY)
GENDER: _____ Female _____Male
SSN (last 4 digits): XXX-XX-_________
RACE: _________________
DRIVER LIC.# _________________
ARRESTING AGENCY: ______________________________________
SID# (if available): _________________
ARREST NUMBER: _________________
ARREST DATE: ______/_____/______ (MM/DD/YY)
THUS ORDERED AND SIGNED this _______ day of _______________, 20 ____
at ________________, Louisiana.
___________________________________
JUDGE
_____________________________
PRINT NAME
PLEASE SERVE:
1. District Attorney: ____________________________________________________________________
2. Arresting Agency: ___________________________________________________________________
3. Parish Sheriff:_______________________________________________________________________
4. Louisiana Bureau of Criminal Identification and Information__________________________________
5. Attorney for Defendant (or defendant)____________________________________________________
FORM 2014 EXP 8-2 (L)