STATE OF LOUISIANA JUDICIAL DISTRICT FOR THE PARISH OF ______________________________ No.: _____________Division: "_______" State of Louisiana vs. _______________________________________________________ MOTION FOR EXPUNGEMENT FOR MISDEMEANOR CONVICTION FOR A FIRST OFFENSE POSSESSION OF MARIJUANA 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 expunge the record of his arrest/conviction pursuant to Louisiana Code of Criminal Procedure Article 971 et seq. and states the following in support: II. MISDEMEANOR CONVICTION FOR A FIRST OFFENSE POSSESSION OF MARIJUANA 1. Mover was convicted on _______/______/_______ (MM/DD/YYYY) 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 expungement of the record of arrest and/or conviction set forth above, including all photographs, fingerprints, disposition, or any other such information, which record shall be confidential and no longer considered a public record, nor be made 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 as an order of this court to any other person for good cause shown, or as otherwise authorized by law. 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
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