Blank Expungement Order 790

AOPC Rev. 0//1 Page 1 of 2 ORDER AND NOW, this day of , 2, after consideration of the presented by , it is ORDERED that the Petition/Motion is . The criminal charges in the above-captioned case specified below are dismissed. The defendant's arrest record regarding these chages shall be expunged. Further,it is ORDERED that the arresting agency shall destroy all criminal records, fingerprints,photographic plates and photographs pertaining to the charge(s) specified below, whichresulted from the arrest(s) of .In addition, all criminal justice agencies upon which this order is served shallexpunge and destroy the official and unofficial arrest and other criminal records, filesand other documents pertaining to the captioned proceedings. The information required under Pa.R.Crim.P. 790 appears on the attached page(s) which is hereby incorporated into this ORDER by reference. BY THE COURT: IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CRIMINAL DIVISION DOCKET NO: Commonwealth of Pennsylvania v. American LegalNet, Inc. www.FormsWorkFlow.com AOPC Rev. 03/0/1 Page 2 of 2 Pursuant to Pa.R.Crim.P. 790, the following information is provided: Name and mailing address of the affiant as shown on the complaint, if available:Docket Number:Offense Tracking Number (OTN):The date on the complaint, or the date of arrest, and if available, the criminal justiceagencythat made the arrest:The specific charges, as they appear on the charging document, to be expunged andapplicable dispositions (attach additional sheets if needed): If the sentence includes a fine, costs, or restitution, whether the amount due has beenpaid:The reason for expungement: 14.The criminal justice agencies upon which certified copies of the order shall be served: Petitioner Name:Alias(es):Petitioner325s Address:Petitioner325s Date of Birth:Petitioner325s Social Security Number:Name and address of the judge of the Court of Common Pleas or PhiladelphiaMunicipalCourt who accepted the guilty plea or heard the case: American LegalNet, Inc. www.FormsWorkFlow.com