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2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Last 4 Digits of SSN*
13. Date of Birth*
    Date of Birth
15. Employment History*
    Include start and end dates for all previous employment
17. Counseling History*
    Include start and end dates for all counseling
19. Reason for Request*
    Please explain the reasons for requesting expungement of your juvenile record. Please be sure to include statements addressing what you learned from your experience in the juvenile justice system.
21. Signature
    Electronically signing this document indicates you have read and understand the expungement guidelines. You also certify under the penalties of perjury that the information you provided is true and accurate.
23. First and Last Name*
24. Date*
    Date
26. Email*
28. Notice
    The Probation Department will make a recommendation to the Court regarding your expungement request. The Court may grant your request without a hearing. If the Court does not summarily grant your request, a formal hearing will be scheduled by the Court.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field