CR-410

Order to Seal Arrest and Related  
Records (Pen. Code, §§ 851.91, 851.92)

Clerk stamps date here when form is filed.

1

Name:

Last

Mailing address: 

Street

City

State

Zip

First

Middle

2

The court finds that the petitioner is eligible for the following requested 
relief and makes the following order:

The court GRANTS the petition. The record of arrest in the 
following matter shall be sealed under the provisions of section 
851.91, and the arrest deemed not to have occurred:  

Clerk fills in the name and street address of the 
court.
Superior Court of California, County of

Law enforcement agency report number: 

Prosecuting agency report number:

Court case number:

Other:
Petitioner may answer any question relating to the sealed arrest as 
though it did not happen, and petitioner is released from all penalties and 
disabilities resulting from the arrest, except as follows:
•  The sealed arrest may be pleaded and proved in any later prosecution 
of the petitioner for any other offense, and will have the same effect 
as if it had not been sealed.

Clerk fills in the number and name of the case.

Trial Court Case Number:

Trial Court Case Name: 
People of the State of California
v.

•  The sealing of an arrest under section 851.91 does not relieve the petitioner of the obligation to disclose the arrest, 
if otherwise required by law, in response to any direct question contained in a questionnaire or application for 
public office, for employment as a peace officer, for licensure by any state or local agency, or for contracting with 
the California State Lottery Commission.

•  The sealing of an arrest under this section does not affect petitioner’s authorization to own, possess, or have in his 
or her custody or control any firearm, or his or her susceptibility to conviction under Chapter 2 (commencing 
with section 29800) of Division 9 of Title 4 of Part 6, if the arrest would otherwise affect this authorization or 
susceptibility. 

•  The sealing of an arrest under this section does not affect any prohibition from holding public office that would 

otherwise apply under law as a result of the arrest.

3

The court DENIES the petition (check one): 

The petition does not meet the requirements listed in Penal Code section 851.91(b)(1).

Petitioner’s arrest does not qualify under Penal Code section 851.91(a).
The court finds that sealing the arrest would not serve the interests of justice under Penal Code section 
851.91(c)(2). 

a.

b.
c.

d.

Date:

Other:

Judicial Council of California, www.courts.ca.gov 
New January 1, 2019, Optional Form

CR-410, Page 1 of 1

Signature of judicial officer

This is a Court Order.

Order to Seal Arrest and Related 
Records (Pen. Code, §§ 851.91, 851.92)