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Here is the text we could read:

In the Court of Common Pleas 
County of ________________
 ____ Judicial District 

In the Interest of: ____________________
Docket No: ___________________

Motion for Expungement Pursuant to Pa.R.J.C.P. 170 

AND NOW, the movant avers the following and requests that this motion for expungement pursuant to 

Pa.R.J.C.P. 170 be granted for the reasons set forth below. 

Name of Juvenile: 

Alias(es): 

JUVENILE INFORMATION 

Date of Birth of Juvenile if known: 

Juvenile’s Case Docket Number, if any:  

Date of Arrest:  

CASE INFORMATION 

Name of law enforcement agency that initiated the 
allegations: 

Reference number of police report or written allegation 
and, if available, the juvenile offense tracking number 
(JOTN):    

List specific allegations or offenses to which the expungement order pertains and the disposition of the written 
allegation or petition (please attach additional sheet(s) of paper if necessary): 

Section 

Subsection  Statute Description 

Counts  Grade  Disposition 

PA 
Statute 
(Title) 

Check the reason(s) and statutory authority for expunging or destroying the documents, fingerprints, or photographs: 

 Written Allegation not approved by prosecution.
 The petition was dismissed by the court.
 Six months have elapsed since the final discharge of the juvenile from supervision under a consent decree and no 

proceeding seeking adjudication or conviction is pending.

 Six months have elapsed since the final discharge of the juvenile from supervision under informal adjustment and 

no proceeding seeking adjudication or conviction is pending.

 The juvenile has been discharged from court supervision pursuant to Rule 631 and five years have elapsed, the 

juvenile has not been convicted or adjudicated delinquent for a felony or misdemeanor, no court proceeding is 
pending seeking such conviction or adjudication and the delinquent act is not an act precluded from expungement 
pursuant to18 Pa. C.S. §9123(a.1).

 The attorney for the Commonwealth consents to the expungement.

Other:    

List the agencies upon which certified copies of the court order shall be served: 

I, the undersigned movant, avers that the facts set forth in this motion are true and correct to the movant’s personal 

knowledge, information or belief . 

_________________________________ 
Signature of Movant 

 __________________ 
 Date 

AOPC Form Updated Rev 7/1/19

Commonwealth of Pennsylvania

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Pennsylvania 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.pacourts.us (2023-03)
Page(s): 1
Fields(s): 58
Average fields per page: 58
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

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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.

docket was Docket No (0.54 conf)
date_birth_juvenile_known was Date of Birth of Juvenile if known (0.40 conf)
aliases_row__1 was AliasesRow1 (0.44 conf)
aliases_row__2 was AliasesRow1_2 (0.40 conf)
aliases_row__3 was AliasesRow2 (0.44 conf)
aliases_row__4 was AliasesRow2_2 (0.40 conf)
statute_description_row__1 was Statute DescriptionRow1 (0.35 conf)
subsection_row__1 was SubsectionRow2 (0.45 conf)
statute_description_row__2 was Statute DescriptionRow2 (0.35 conf)
counts_row__1 was CountsRow2 (0.45 conf)
subsection_row__2 was SubsectionRow3 (0.45 conf)
statute_description_row__3 was Statute DescriptionRow3 (0.35 conf)
counts_row__2 was CountsRow3 (0.45 conf)
subsection_row__3 was SubsectionRow4 (0.45 conf)
statute_description_row__4 was Statute DescriptionRow4 (0.35 conf)
counts_row__3 was CountsRow4 (0.45 conf)
subsection_row__4 was SubsectionRow5 (0.45 conf)
counts_row__4 was CountsRow5 (0.45 conf)
interest was In the Interest of (0.37 conf)
county was County (0.39 conf)
judicial_district was JudicialDistrict (0.38 conf)
name_juvenile was Name of Juvenile (0.35 conf)
date_arrest was Date of Arrest (0.47 conf)
law_enforcement_agency was Law Enforcement Agency (0.55 conf)
docket_number was Docket Number (0.34 conf)
otn was OTN (0.47 conf)
subsection_row__5 was SubsectionRow1 (0.45 conf)
section_row__1 was SectionRow2 (0.27 conf)
section_row__2 was SectionRow3 (0.27 conf)
section_row__3 was SectionRow4 (0.27 conf)
section_row__4 was SectionRow5 (0.27 conf)
section_row__5 was SectionRow1 (0.27 conf)
title_row__1 was TitleRow1 (0.27 conf)
title_row__2 was TitleRow2 (0.27 conf)
title_row__3 was TitleRow3 (0.27 conf)
title_row__4 was TitleRow4 (0.27 conf)
title_row__5 was TitleRow5 (0.27 conf)
counts_row__5 was CountsRow1 (0.45 conf)
grade_row__1 was GradeRow2 (0.31 conf)
grade_row__2 was GradeRow3 (0.31 conf)
grade_row__3 was GradeRow4 (0.31 conf)
grade_row__4 was GradeRow5 (0.31 conf)
grade_row__5 was GradeRow1 (0.31 conf)
disposition_row__1 was DispositionRow2 (0.46 conf)
disposition_row__2 was DispositionRow3 (0.46 conf)
disposition_row__3 was DispositionRow1 (0.46 conf)
disposition_row__4 was DispositionRow4 (0.46 conf)
disposition_row__5 was DispositionRow5 (0.46 conf)
reason__1 was Reason1 (0.35 conf)
reason__2 was Reason2 (0.35 conf)
reason__3 was Reason3 (0.35 conf)
reason__4 was Reason4 (0.35 conf)
reason__5 was Reason6 (0.35 conf)
reason__6 was Reason5 (0.35 conf)
statute_description_row__5 was Statute DescriptionRow5 (0.35 conf)
reason__7 was OtherReason (0.41 conf)
signature_date was Date (1.00 conf)
agencies_served was AgenciesServed (0.39 conf)

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

Commonwealth of Pennsylvania

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Identified Data Fields:

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