Art. 989. Motion for expungement forms to be used

STATE OF LOUISIANA

JUDICIAL DISTRICT FOR THE PARISH OF

______________________________

No.: _____________Division: "_______"

State of Louisiana

vs.

_______________________________________________________

MOTION FOR 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 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.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, but it did not result in conviction

_____ YES _____ NO           Convicted of and seeks to expunge a misdemeanor

_____ YES _____ NO Convicted of and seeks to expunge a felony

_____ YES _____ NO           Convicted but determined to be factually innocent and entitled to compensation for a wrongful conviction pursuant to the provisions of R.S. 15:572.8.

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    ARRESTS THAT DID NOT RESULT IN CONVICTION

NO. 1              La. Rev. Stat. Ann.                                         § _______ : ________

Name of the offense                           __________________

( ) Time expired for prosecution__________________

(MM/DD/YYYY)

( ) Not prosecuted for any offense

arising out of this charge.

( ) Pre-trial Diversion Program.

( ) DWI Pre-Trial Diversion Program

and 5 years have elapsed since the

date of arrest.

( ) Charge dismissed

( ) Found not guilty/judgment of acquittal

NO. 2              La. Rev. Stat. Ann.                                         § _______ : ________

Name of the offense                           __________________

( ) Time expired for prosecution__________________

(MM/DD/YYYY)

( ) Not prosecuted for any

offense arising out of this charge.

( ) Pre-trial Diversion Program.

( ) Charge dismissed

( ) Found not guilty/judgment of acquittal

NO. 3              La. Rev. Stat. Ann.                                         § _______ : ________

Name of the offense                           __________________

( ) Time expired for prosecution__________________

(MM/DD/YYYY)

( ) Not prosecuted for any offense

arising out of this charge.

( ) Pre-trial Diversion Program.

( ) Charge dismissed

( ) Found not guilty/judgment of acquittal

____ Yes ____ No    MISDEMEANOR CONVICTIONS

NO. 1              La. Rev. Stat. Ann.                                         § _______ : ________

Name of the offense                             _________________

( ) Conviction set aside/dismissed      _____/____/_______

pursuant to C.Cr.P. Art. 894(B)          (MM/DD/YYYY)

( ) More than 5 years have passed

since completion of sentence.

NO. 2              La. Rev. Stat. Ann.                                         § _______ : ________

Name of the offense                             _________________

( ) Conviction set aside/dismissed      _____/____/_______

pursuant to C.Cr.P. Art. 894(B)          (MM/DD/YYYY)

( ) More than 5 years have passed

since completion of sentence.

____ Yes ____ No    FELONY CONVICTIONS

NO. 1              La. Rev. Stat. Ann.                                         § _______ : ________

( ) Conviction set aside/dismissed      _____/____/_______

pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)

( ) More than 10 years have passed

since completion of sentence

NO. 2              La. Rev. Stat. Ann.                                         § _______ : ________

( ) Conviction set aside/dismissed      _____/____/_______

pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)

( ) More than 10 years have passed

since completion of sentence

____ Yes ____ No     OPERATING A MOTOR VEHICLE WHILE INTOXICATED CONVICTIONS

Mover has attached the following:

( )       A copy of the proof from the Department of Public Safety and Corrections, office of motor vehicles, that it has received from the clerk of court a certified copy of the record of the plea, fingerprints of the defendant, and proof of the requirements set forth in C.Cr.P. Art. 556, which shall include the defendant's date of birth, last four digits of social security number, and driver's license number

5. Mover has attached to this Motion the following pertinent documents:

□          Criminal Background Check from the La. State Police/Parish Sheriff dated within the past 60 days (required).

□          Bill(s) of Information (if any).

□          Minute entry showing final disposition of case (if any).

□          Certification Letter from the District Attorney for fee waiver (if eligible).

□          Certification Letter from the District Attorney verifying that the applicant has no convictions or pending applicable criminal charges in the requisite time periods.

□          Certification Letter from the District Attorney verifying that the charges were refused.

□          Certification Letter from the District Attorney verifying that the applicant did not participate in a pretrial diversion program.

□          A copy of the order waiving the sex offender registration and notification requirements.

□          Documentation verifying that the mover has been employed for ten consecutive years.

□          A copy of the court order determination of factual innocence and order of compensation for a wrongful conviction pursuant to the provisions of R.S. 15:572.8 if applicable.

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

Acts 2014, No. 145, §1; Acts 2015, No. 200, §1; Acts 2016, No. 125, §1, eff. May 19, 2016; Acts 2018, No. 711, §1.