Criminal Record Vacatur Request Form

Criminal Record Vacatur Request Form
Use this form to request review of a criminal record for vacatur-related relief and to provide the information needed to evaluate and process the request.
Requester Information
Full Name
First NameMiddle NameLast Name
Preferred Contact Method
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Record and Request Details
Case or Record Identifier
Jurisdiction, Court, or Agency Name
Date of Conviction or Case Resolution
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Request
Other
Brief Explanation for Request
Supporting Documentation and Submission Notes
Supporting Documents
Cancelof
Additional Notes for Reviewer
Should be Empty: