JUDICIAL DISTRICT FOR THE PARISH OF ______________________________ No.: _____________Division: "_______" State of Louisiana vs. _______________________________________________________ ORDER OF EXPUNGEMENT UNDER CODE OF CRIMINAL PROCEDURE ARTICLE 999 Pursuant to Code of Criminal Procedure Article 999, wherein all of the following applies, (1) The defendant was seventeen years of age when the defendant was arrested or charged with any criminal offense as provided in Title 14 or 40 of the Louisiana Revised Statutes of 1950. (2) The district attorney, for any reason, declined to prosecute all offenses arising out of that arrest, including the reason that the person successfully completed a pretrial diversion program. (3) Prosecution was instituted and such proceedings have been finally disposed of by dismissal, sustaining of a motion to quash, or acquittal. IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that the following charges and arrest on the dates provided herein be expunged. THUS ORDERED AND SIGNED, ADJUDGED, AND DECREED this ____ day of ___________, 20 ____ at ______________, Louisiana, ___________________________. ___________________________ JUDGE DEFENDANT INFORMATION: NAME:________________________________________________ First Middle Last DATE OF BIRTH:_____________ GENDER:_____________ SS#___________________________ RACE___________________________ DRIVER'S LICENSE#___________________ ARRESTING AGENCY___________________ SID#___________________ ARREST NUMBER (ATN)___________________ AGENCY ITEM NO:________________________ 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)____________________________ 6. Clerk of Court ____________________________
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