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STATE OF MICHIGAN

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

APPLICATION FOR
HUMAN TRAFFICKING VICTIM
TO SET ASIDE CONVICTION(S)

Court address

CASE NO. and JUDGE

This application includes multiple case

numbers as listed in item 1.

Court telephone no.

ORI
MI-

Police Report No.

THE PEOPLE OF

The State of Michigan

Use note: If you are asking to have a conviction set aside that is not
the direct result of you being a victim of a human trafficking violation,
you must use MC 227.

If you are asking to have a misdemeanor marihuana related conviction
set aside under MCL 780.621e, you must use form MC 227a.

Defendant’s name, address, and telephone no.

CTN/TCN

SID

Defendant’s attorney, bar no., address, and telephone no.

1. I request that the court issue an order to set aside the conviction(s) listed below as provided by law. I consent to use of

conviction is attached. Use additional sheet(s) if more space is necessary.

the nonpublic record created by MCL 780.623 to the extent authorized by MCL 780.623. A certified copy of each

CRIME

CHARGE CODE(S)
MCL citation/PACC Code

DATE OF
CONVICTION

CASE NUMBER

2. I meet the criteria to have 1 or more convictions set aside under MCL 780.621(3) and the following facts support that the
convictions I am seeking to set aside are a direct result of my being a victim of a human trafficking violation:

*A person who is convicted of a violation of MCL 750.448, MCL 750.449, and MCL 750.450, or a local ordinance substantially corresponding to those
statutes, may apply to have that conviction set aside if he or she committed the offense as a direct result of his or her being a victim of a human trafficking
violation.

Approved, SCAO
Form MC 227b, Rev. 3/23
MCL 780.621, MCL 780,621b, MCL 780.621d, MCL 780.622,
MCL 780.623, MCL 780.772a, MCL 780.827a
Page 1 of 3

Distribute form to:
Court
Defendant
Prosecuting official
Attorney General
State Police
Return

Application for Human Trafficking Victim to Set Aside Conviction(s)
Page 2 of 3

(3/23)

Case No.

a. No other application was previously filed to set aside a conviction listed in item 1.
b. An application was previously filed in a court to set aside the following conviction(s) listed in item 1:

CRIME

CHARGE CODE(S)
MCL citation/PACC Code

DATE OF
CONVICTION

CASE NUMBER

DISPOSITION

a. No other application was previously filed in a court to set aside other conviction(s).
b. An application was previously filed in a court to set aside the following conviction(s):

List only applications that have been previously filed with a court. Do not include applications you may be filing in the future - even later the
same day.

CRIME

CHARGE CODE(S)
MCL citation/PACC Code

DATE OF
CONVICTION

CASE NUMBER

DISPOSITION

I have not had any convictions deferred and dismissed.

I have had the following conviction(s) deferred

and dismissed:

6. There are no other criminal charges pending against me.

Applicant Signature

Subscribed and sworn to before me on

Date

My commission expires on

Notary public, State of Michigan, County of

Deputy clerk/Notary public signature

Name (type or print)

Acting in the County of

This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

Application for Human Trafficking Victim to Set Aside Conviction(s)
Page 3 of 3

(3/23)

Case No.

The hearing cannot be held until the court receives
the Michigan State Police report required by
MCL 780.621(d)(8).

NOTICE OF HEARING

TO: Michigan Attorney General and

Prosecuting official

A hearing will be held on the above application to set aside conviction on

Location

Date and time

before

Judge

PROOF OF SERVICE

I certify that copies of this application and certified record of conviction

and notice of hearing

were served on the

prosecuting official on

Attorney General on

Date

by first-class mail addressed to the last-known address.

I certify that copies of this application, certified record of conviction, and the fingerprint card, accompanied by the required fee, were

served on the Michigan State Police on

by first-class mail addressed to the last-known address.

Date

I declare under the penalties of perjury that this proof of service has been examined by me and that its contents are true to
the best of my information, knowledge, and belief.

Date

Applicant/Attorney signature

Instructions for Filing and Serving an Application for Human Trafficking Victim to Set Aside Conviction(s)
(Form MC 227b)

For additional instructions and an online interview that will help you create forms, go to michiganlegalhelp.org.

1. Determine whether you are eligible to apply to have your conviction set aside according to MCL 780.621 -
MCL 780.621d.

3. If you are asking to have a misdemeanor marihuana related conviction set aside under MCL 780.621e, you must use

form MC 227a. If you are asking to have any other conviction set aside that is not the direct result of you being a
victim of a human trafficking violation under MCL 780.621(1), you must use form MC 227.

4. Find out the exact date of each conviction and each charge from the court. Get a certified copy of each conviction

from the clerk of the court in which you were convicted and attach it to your application. There may be a fee to obtain
these certified copies.

. Swear to the truth of the statements in this application and then sign it in the presence of the court clerk or a notary

public.

2. You must file the application in the court where the conviction occurred. You must use a separate application for
each court.

6. Make five copies of all attachments and this application. Take all copies to the court clerk.

7. Depending on local practice, the clerk of the court may set a hearing date at the time of filing. If a hearing date is set
at the time of filing, the clerk of the court will complete the Notice of Hearing.

8. Go to the local law enforcement agency for a fingerprint card and get fingerprinted on the applicant card (RI-008).
There may be a fee for fingerprinting. Fill out the card completely.

9. Make out a money order or check to the State of Michigan for the application. The application fee is $50.00. This fee

is sent with the application packet to the Michigan State Police for processing.

10. Mail a copy of the application packet, application fee, and the fingerprint card to the Michigan State Police by first-

class mail to Michigan State Police, Criminal Justice Information Center - Criminal History, PO Box 30266, Lansing,
Michigan 48909.

11. Mail a copy of the application packet to the Attorney General of the State of Michigan by first-class mail to Office of

the Attorney General, Criminal Trials and Appeals Division, PO Box 30212, Lansing, Michigan 48909.

12. Mail a copy of the application packet to the correct prosecuting official where the conviction occurred (county, city,

or township) by first-class mail.

13. On both remaining copies of the application, fill in the Proof of Service on page 3. After you fill out and sign the

Proof of Service, mail or take one of the remaining application packets with the completed Proof of Service to the
court. Keep the other copy of the application packet for your records.

Approved, SCAO
Form INST MC 227b, Rev. 1/23
Page 1 of 1

MC 227b, Application for Human Trafficking Victim to Set Aside Conviction(s)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan 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 www.courts.michigan.gov/criminal-felony-forms (2023-03)
Page(s): 4
Fields(s): 100
Average fields per page: 25
Reading Level: Grade 8
LIST Grouping(s): CO-00-00-00-00, CR-00-00-00-00, CO-07-00-00-00.

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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e_code_mc_l_citation_pac__1 was CHARGE CODES MCL citationPACC Codea (0.46 conf)
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e_code_mc_l_citation_pac_c__1 was CHARGE CODES MCL citationPACC CodeRow1 (0.39 conf)
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commission_expires was My commission expires on (0.40 conf)
undefined__2 was undefined_3 (0.39 conf)
public_state_michigan_county was Notary public State of Michigan County of (0.51 conf)
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We've done our best to group similar variables togther to avoid overwhelming the user.

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

MC 227b, Application for Human Trafficking Victim to Set Aside Conviction(s)

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