La. Code Crim. Proc. art. 994

STATE OF LOUISIANA

JUDICIAL DISTRICT FOR THE PARISH OF

______________________________

No.: _____________Division: "_______"

State of Louisiana

vs.

_______________________________________________________

MOTION FOR INTERIM 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)

SEX _____ 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 an interim expungement of the entry of the felony charge(s) of his arrest pursuant to Louisiana Code of Criminal Procedure Article 985.1 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 for a felony offense.

_____ YES _____ NO Convicted of a misdemeanor arising out of that felony offense.

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 FELONY ARREST THAT RESULTED IN A MISDEMEANOR CONVICTION

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

Name of the offense __________________

__________________

(MM/DD/YYYY)

( ) Felony charge dismissed.

( ) Convicted of misdemeanor offense arising out of

felony arrest.

5. Mover has attached to his Motion a criminal background check from the Louisiana State Police/Parish Sheriff dated within the past sixty days (required).

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 Louisiana Bureau of Criminal Identification and Information to expunge the entry of the felony charge(s) listed contained in the criminal history; and further that the Clerk of Court, District Attorney, and arresting law enforcement agency expunge the entry of those felony charge(s) from any public indices.

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

PLEASE SERVE:

1. District Attorney______________________________________________

2. Louisiana Bureau of Criminal Identification and Information___________

3. Arresting Agency ______________________________________________