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
Date
Type of Request
Other
Brief Explanation for Request
Supporting Documentation and Submission Notes
Supporting Documents
Cancelof
Additional Notes for Reviewer
Should be Empty: