THE PEOPLE OF

 The State of Michigan

 
 

In the matter of 
 

Defendant’s/Juvenile’s name, address, and telephone no.

v

CTN/TCN

SID

Count

CRIME

CHARGE CODE(S)
MCL citation/PACC Code

USE NOTE: This form is for use when the arresting agency or the Michigan State Police has failed to destroy the biometric data and arrest record as 
required by law or when the Michigan State Police has not destroyed the biometric data and arrest record because the defendant has had a prior conviction 
as stated in MCL 28.243(14)(h). This form is not for use in conjunction with setting aside an adjudication pursuant to MCL 712A.18e or setting aside a 
conviction pursuant to MCL 780.621.

1. I, 

Name (type or print)

MOTION

 , state that on 

Date

    not destroyed the biometric data and arrest record as required by law.

 I was found not guilty of all offense(s) charged in this case, and the arresting agency and/or Michigan State Police has

 I was found not to be within the provisions of MCL 712A.2.
 The charges in this case were dismissed by nolle prosequi before trial, and the arresting agency and/or Michigan  

 
 
 
 
 
2. This motion does not pertain to any sentence imposed under MCL 333.7411, MCL 600.1076(4), MCL 762.11-
  MCL  762.15, MCL 769.4a, MCL 750.350a, MCL 750.430, or to one of the crimes listed in MCL 28.243(14).

    State Police has not destroyed the biometric data and arrest record as required by law.

 

3. I REQUEST that my biometric data and arrest record be destroyed by the arresting agency and/or Michigan State Police.

Date

 

Signature

NOTICE OF HEARING

A hearing will be held on this motion on 

Date and time

at 

Location

 before Hon. 

.

 .

 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITCOUNTY MOTION FOR DESTRUCTION OFBIOMETRIC DATA AND ARREST RECORDCASE NO. and JUDGEORIMI-Court addressCourt telephone no.Police Report No.Approved, SCAOForm MC 235, Rev. 1/21MCL 28.243, MCL 780.621, MCL 780.623, MCR 3.936(D)Page 1 of 2Distribute form to: Court Prosecutor Defendant JIS Code: MFOMotion for Destruction of Biometric Data and Arrest Record 
Page 2 of 2

(1/21) 

Case No. 
 

CERTIFICATE OF MAILING

I served a copy of this motion and notice of hearing on the parties or their attorneys by first-class mail addressed to their 
last-known addresses as defined by MCR 2.107(C)(3). I declare under the penalties of perjury that this certificate of mailing 
has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Date

 

Signature