STATE OF LOUISIANA JUDICIAL DISTRICT FOR THE PARISH OF ______________________________ No.: _____________Division: "_______" State of Louisiana vs. _______________________________________________________ MOTION FOR INTERIM EXPUNGEMENT NOW INTO COURT comes mover, who provides the court with the following information in connection with this request: I.DEFENDANT INFORMATION NAME: ___________________________________________________________ (Last, First, MI) DOB: ________/______/_______ (MM/DD/YYYY) GENDER _____ Female _____Male SSN (last 4 digits): XXX-XX-________ RACE: _________________ DRIVER LIC.# _________________ ARRESTING AGENCY: __________________________________________ SID# (if available): _________________ ARREST NUMBER (ATN): _________________ AGENCY ITEM NO. ________________ Mover is entitled to an interim expungement of the entry of the felony charge(s) of his arrest pursuant to Louisiana Code of Criminal Procedure Article 985.1 and states the following in support: II.ARREST INFORMATION 1. Mover was arrested on _______/______/_______ (MM/DD/YYYY) 2. _____ YES _____ NO A supplemental sheet with arrests and/or convictions is attached after page 2 of this Motion. 3.Mover was: _____ YES _____ NO Arrested for a felony offense. _____ YES _____ NO Convicted of a misdemeanor arising out of that felony offense. 4. Mover was booked and/or charged with the following offenses: (List each offense booked and charged separately. Attach a supplemental sheet, if necessary.) ____ Yes ____ No FELONY ARREST THAT RESULTED IN A MISDEMEANOR CONVICTION NO. 1 La. Rev. Stat. Ann. § _______ : ________ Name of the offense __________________ __________________ (MM/DD/YYYY) ( ) Felony charge dismissed. ( ) Convicted of misdemeanor offense arising out of felony arrest. 5. Mover has attached to his Motion a criminal background check from the Louisiana State Police/Parish Sheriff dated within the past sixty days (required). The mover prays that if there is no objection timely filed by the arresting law enforcement agency, the District Attorney's Office, or the Louisiana Bureau of Criminal Identification and Information, that an order be issued herein ordering the Louisiana Bureau of Criminal Identification and Information to expunge the entry of the felony charge(s) listed contained in the criminal history; and further that the Clerk of Court, District Attorney, and arresting law enforcement agency expunge the entry of those felony charge(s) from any public indices. If an "Affidavit of No Opposition" by each agency named herein is attached hereto and made a part hereof, Defendant requests that no contradictory hearing be required and the Motion be granted ex parte. Respectfully submitted, ____________________________________ Signature of Attorney for Mover/Defendant ____________________________________ Attorney for Mover/Defendant Name ____________________________________ Attorney's Bar Roll No. ____________________________________ Address ____________________________________ City, State, ZIP Code ____________________________________ Telephone Number If not represented by counsel: ____________________________________ Signature of Mover/Defendant ____________________________________ Mover/Defendant Name ____________________________________ Address ____________________________________ City, State, ZIP Code ____________________________________ Telephone Number PLEASE SERVE: 1. District Attorney______________________________________________ 2. Louisiana Bureau of Criminal Identification and Information___________ 3. Arresting Agency ______________________________________________
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