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Here is the text we could read:

CR-409

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

Clerk stamps date here when form is filed.

Your Information
a.

Petitioner (the person who is filing this petition):
Name:

Last

First

(mm/dd/yyyy)

Date of birth:

Street address:

Street

City

State

Zip

Mailing address (if you have a lawyer for this case, give your lawyer's
information ):

Street

City

Phone:

E-mail (if available):

State Bar number:

State

Zip

2 Notice of Court Hearing

A court hearing is scheduled on this petition as follows:

Hearing
Date

Date:

Dept.:

Time:

Room:

Name and address of court if different from above:

Fill in the name and street address of the court
that you are filing the petition in:
Superior Court of California, County of

Fill this out if a criminal complaint was filed or
charged against the petitioner, and there is a case
number and case name for that criminal case. Do
not fill this out if an arrest happened but no
criminal complaint was filed or charged in court:

Trial Court Case Number:

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

If an interpreter is needed, please specify the language:

Information About Your Case
a.

Date of the arrest you are requesting to be sealed:

Where did the arrest happen? Include the city and county:

(mm/dd/yyyy)

What law enforcement agency made the arrest? If it was a police department, include the city (for example, ABC
City Police Department). If it was a county sheriff, list the county

(for example, XYZ County Sheriff):

d. What is the arrest report number or police report number, if available?

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

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

CR-409, Page 1 of 2

Trial Court Case Name:

Trial Court Case Number:

Include any other information about the arrest that is available from the prosecutor (district attorney/city
attorney) or the court, including the case number that the prosecutor used to review the arrest or used to file a
case against you. If you would like to explain the information provided, please do so below, or complete and
attach the Attached Declaration (form MC-031) or submit other relevant documents.

f. Add any information on offenses or charges based on the arrest. If you would like to explain the information

provided, please do so below, or complete and attach the Attached Declaration (form MC-031) or submit other
relevant documents.

g. If the prosecutor filed a case against you, please include what the charges were (for example, Pen. Code, § 242,

for battery).

h. Choose one:

I am entitled to have this arrest (the arrest described in item of this petition) sealed as a matter of right
because the arrest did not result in a conviction, and I satisfy the requirements of Penal Code section 851.91.

I am requesting to have the arrest sealed in the interests of justice (Pen. Code, § 851.91(c)(2)(B)).
(Describe below how this is in the interests of justice. In deciding whether to grant this request, the court
may consider any important factors, including: hardship and difficulties caused by the arrest; statements
or evidence regarding your good character; statements or evidence regarding the arrest; your record of
convictions; or any other important factors. You may provide statements or evidence from you, from
others, or both.)

Please attach any additional signed and dated statements with the petition.

I declare under penalty of perjury under the laws of the State of California that the foregoing statements are true and
correct, except as to matters that are stated on my information and belief, and as to those matters, I believe them to be true.

Date:

New January 1, 2019

Signature of petitioner or attorney

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

CR-409, Page 2 of 2

Petition to Seal Arrest and Related Records

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 35
Average fields per page: 17
Reading Level: Grade 8
LIST Grouping(s): CR-00-00-00-00, CO-07-00-00-00, CO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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topmost_page_case_name_ft was topmostSubform[0].Page1[0].TCCaseName_ft[0] (0.39 conf)
topmost_subform_page__1 was topmostSubform[0].Page1[0].T186[0] (0.38 conf)
topmost_subform_page_area was topmostSubform[0].Page1[0].#area[1].T186[1] (0.38 conf)
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topmost_subform_page_fill_text__3 was topmostSubform[0].Page1[0].FillText37[0] (0.44 conf)
topmost_subform_page_fill_text__4 was topmostSubform[0].Page1[0].FillText37[1] (0.44 conf)
topmost_subform_page__2 was topmostSubform[0].Page1[0].T141[0] (0.38 conf)
topmost_subform_page_fill_text__5 was topmostSubform[0].Page1[0].FillText38[2] (0.44 conf)
topmost_subform_page__3 was topmostSubform[0].Page1[0].T140[0] (0.38 conf)
topmost_subform_page_fill_text__6 was topmostSubform[0].Page1[0].FillText38[3] (0.44 conf)
topmost_subform_page_fill_text__7 was topmostSubform[0].Page1[0].FillText37[2] (0.44 conf)
topmost_subform_page_fill_text__8 was topmostSubform[0].Page1[0].FillText37[3] (0.44 conf)
topmost_subform_page__4 was topmostSubform[0].Page1[0].T158[0] (0.38 conf)
topmost_subform_page__5 was topmostSubform[0].Page1[0].T186[2] (0.38 conf)
topmost_subform_page__6 was topmostSubform[0].Page1[0].T186[3] (0.38 conf)
topmost_subform_page__7 was topmostSubform[0].Page1[0].T66[0] (0.38 conf)
topmost_subform_page__8 was topmostSubform[0].Page1[0].T186[4] (0.38 conf)
topmost_subform_page__9 was topmostSubform[0].Page1[0].T158[1] (0.38 conf)
topmost_subform_page__10 was topmostSubform[0].Page1[0].T159[0] (0.38 conf)
topmost_subform_page__11 was topmostSubform[0].Page1[0].T160[0] (0.38 conf)
topmost_subform_page__12 was topmostSubform[0].Page1[0].T161[0] (0.38 conf)
topmost_subform_page__13 was topmostSubform[0].Page1[0].T162[0] (0.38 conf)
topmost_subform_page__14 was topmostSubform[0].Page1[0].T186[5] (0.38 conf)
topmost_subform_page_px_capton_sf_case_number_ft was topmostSubform[0].Page3[0].PxCapton_sf[0].CaseNumber_ft[0] (0.39 conf)
topmost_subform_page_px_capton_sf_tc_case_name_ft was topmostSubform[0].Page3[0].PxCapton_sf[0].TCCaseName_ft[0] (0.39 conf)
topmost_page_dismiss_section__1 was topmostSubform[0].Page3[0].DismissSection_cb[0] (0.35 conf)
topmost_page_dismiss_section__2 was topmostSubform[0].Page3[0].DismissSection_cb[1] (0.35 conf)
topmost_subform_page_fill_text__9 was topmostSubform[0].Page3[0].FillText97[0] (0.44 conf)
topmost_subform_page__15 was topmostSubform[0].Page3[0].T66[0] (0.38 conf)
topmost_subform_page__16 was topmostSubform[0].Page3[0].T66[1] (0.38 conf)
topmost_subform_page__17 was topmostSubform[0].Page3[0].T66[2] (0.38 conf)
topmost_subform_page__18 was topmostSubform[0].Page3[0].T66[3] (0.38 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition to Seal Arrest and Related Records

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02