Request To Expunge Arrest Record printable pdf download

Request To Expunge Arrest Record

REQUEST TO EXPUNGE

ARREST RECORD

O.C.G.A. 35-3-37(d)

SECTION (1) ONE - APPLICANT INFORMATION

(to be completed by requester)

Name

Date of Birth

Race

Sex

Social Security Number

Street Address

City

State

Zip Code

Arresting Agency:

Date of Arrest

Offense(s) Arrested For:

(NOTE: Arresting or Prosecuting Agencies may require the use of separate forms for

each date of arrest to be expunged.)

Sections One and Two of this form must be completed in their entirety before request

may be submitted to the Prosecuting Attorney’s Office.

I request the arrest record information described above pertaining to me be expunged from the

record(s) of the arresting agency pursuant to the provisions of O.C.G.A. 35-3-37(d).

Signature

Date

O.C.G.A. 35-3-37(d)(1) provides in part that “An individual who was: (A) Arrested for an offense under the laws of this state but

subsequent to such arrest is released by the arresting agency without such offense being referred to the prosecuting attorney for

prosecution; or (B) After such offense referred to the proper prosecuting attorney, and the prosecuting attorney dismisses the charges

without seeking an indictment or filing an accusation may request the original agency in writing to expunge the records of such

arrest...”

GCIC Record Expungement Form

Rev 3/2006

Request To Expunge Arrest Record