Here is the text we could read:
Commonwealth of Pennsylvania
Kominote Pennsylvania
v / kont
________________________________
Docket No / Nimewo Lis Dosye: CP 20
In the Court of Common Pleas
County of _______________
________ Judicial District
Nan Tribinal Defans an Komen
Konte _______________
________ Distri Jidisyè
Petition for Expungement Pursuant to
Pa.R.Crim.P. 490
Petisyon pou Anilasyon Selon
Pa.R.Crim.P. 490
AND NOW, the petitioner avers the following and
requests that this petition for expungement pursuant to
Pa.R.Crim.P. 490 be granted for the reasons set forth
below.
EPI KOUNYE A, moun k ap mande a deklare sa ki vini
annapre a epi li mande pou yo akòde petisyon pou
anilasyon sa a selon Pa.R.Crim.P. 490 pou rezon ki
prezante anba a.
PETITIONER INFORMATION / ENFÒMASYON SOU MOUN K AP MANDE A
Full Name:
Non Konplè:
Address:
Adrès:
DOB:
Dat Nesans:
Alias(es): / Alyas:
Social Security Number:
Nimewo Sekirite Sosyal:
CASE INFORMATION / ENFÒMASYON SOU KA A
List name, address of Judge of the Magisterial District or Philadelphia Municipal Court who accepted the guilty plea or heard the
case: / Endike non, adrès Jij nan Tribinal Distri Majistral la oswa Tribinal Minisipal Philadelphia ki te aksepte pledwaye pou
koupab la oswa ki te tande ka a:
Judge:
Jij:
Magisterial District Court Number:
Nimewo Tribinal Distri Majistral:
Philadelphia Municipal Court or Magisterial District Docket Number:
Nimewo Lis Dosye Tribinal Minisipal oswa Distri Majistral Philadelphia:
Name of Arresting Agency:
Non Ajans Arestasyon an:
Address:
Adrès:
Date of Arrest:
Dat Arestasyon an:
Date on Citation or Complaint:
Dat ki sou Sitasyon oswa Plent
lan:
List name and mailing address of the affiant as shown on the complaint or citation, if available: / Endike non ak adrès postal
deklaran an jan li afiche sou plent lan oswa sitasyon an, si li disponib:
Name of Affiant:
Non Deklaran an:
Address:
Adrès:
List specific charges, as they appear on the charging document, to be expunged and the disposition of each charge (please attach
additional sheet(s) of paper if necessary): / Endike akizayon espesifik, jan yo parèt sou dokiman akizasyon an, pou yo anile a ak
dispozisyon pou chak akizasyon (tanpri atache yon fèy papye anplis si sa nesesè):
PA Statute
(Title)
Lwa PA
(Tit)
Statute Description
Deskripsyon Lwa
Counts
Chèf
Akizasyon
Subsection
Sou-seksyon
Disposition
Dispozisyon
Section
Seksyon
Grade
Grad
If the sentence imposed included a fine, costs or restitution, has the amount due been paid? / Si kondanasyon yo enpoze a te gen
ladan yon amann, frè oswa restitisyon, èske w te peye montan ou te dwe a? Yes/Wi No/Non
List the reason(s) for the expungement (please attach additional sheet(s) of paper if necessary): / Endike rezon pou anilasyon an
(tanpri atache yon fèy papye anplis si sa nesesè):
I have attached a copy of my Pennsylvania State Police Criminal History which I have obtained within 60 days before filing this
petition. / Mwen te atache yon kopi Kazye Jidisyè Polis Eta Pennsylvania mwen te jwenn nan espas 60 jou anvan m te depoze
petisyon sa a.
I have not attached a copy of my Pennsylvania State Police Criminal History. State reason(s) below: / Mwen pa t atache yon
kopi Kazye Jidisyè Polis Eta Pennsylvania mwen an. Di rezon an (yo) anba a:
When this petition is filed with the Clerk of Courts, the
petitioner shall serve a copy upon the attorney for the
Commonwealth.
I, the undersigned petitioner, avers that the
facts set forth in this petition are true and correct to
the best of my personal knowledge or information
and belief, and are made subject to the penalties of
unsworn falsification to authorities under 18 Pa.C.S §
4904.
Lè yo depoze petisyon nan Grèf Tribinal la, moun k ap
mande a ta dwe bay avoka Kominote a yon kopi.
Mwen, moun k ap mande ki siyen anba a,
deklare fè ki prezante nan petisyon sa a se verite epi
yo kòrèk selon pi bon konesans, enfòmasyon, ak
kwayans mwen, epi yo fèt pandan mwen konnen
penalite ki genyen pou moun ki bay otorite fo
enfòmasyon ki pa fèt sou sèman selon 18 Pa.C.S §
4904.
Signature of Petitioner
Siyati Moun k ap Mande a
Date
Dat
AOPC Form Updated Rev 03/09/12
Haitian Creole Petition for Expungement Pursuant to Pa.R.Crim.P. 490
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)
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About This Form:
- Sourced from www.pacourts.us (2023-03)
- Page(s): 2
- Fields(s): 77
- Average fields per page: 38
- 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.
county__1 was CountyOf (0.58 conf)district__1 was District# (0.27 conf)defendant was Defendant (1.00 conf)docket_seg__1 was DocketSeg1 (0.31 conf)docket_seg__2 was DocketSeg2 (0.31 conf)docket_seg__3 was DocketSeg3 (0.31 conf)docket_seg__4 was DocketSeg4 (0.31 conf)county__2 was CountyOf_T (0.38 conf)district__2 was District#_T (0.31 conf)full_name was Full Name (0.33 conf)addr__1 was Addr1 (0.35 conf)addr__2 was Addr2 (0.35 conf)addr_city was AddrCity (0.36 conf)addr_state was AddrState (0.44 conf)addr_zip was AddrZip (0.33 conf)users1_birthdate was DOB (1.00 conf)social_security_number was Social Security Number (0.38 conf)aliases__1 was Aliases1 (0.35 conf)aliases__2 was Aliases2 (0.35 conf)aliases__3 was Aliases3 (0.35 conf)aliases__4 was Aliases4 (0.35 conf)aliases__5 was Aliases5 (0.35 conf)judge was Judge (0.39 conf)md_j_number was MDJ Number (0.45 conf)judge_addr__1 was JudgeAddr1 (0.39 conf)judge_addr__2 was JudgeAddr2 (0.39 conf)judge_addr_city was JudgeAddrCity (0.38 conf)judge_addr_state was JudgeAddrState (0.42 conf)judge_addr_zip was JudgeAddrZip (0.35 conf)cp_docket_number was CPDocketNumber (0.31 conf)name_arresting_agency was Name of Arresting Agency (0.44 conf)date_arrest was Date of Arrest (0.47 conf)date_complaint was Date on Complaint (0.38 conf)name_affiant was Name of Affiant (0.39 conf)affiant_addr__1 was AffiantAddr1 (0.35 conf)affiant_addr__2 was AffiantAddr2 (0.35 conf)affiant_addr_city was AffiantAddrCity (0.36 conf)affiant_addr_state was AffiantAddrState (0.44 conf)affiant_addr_zip was AffiantAddrZip (0.33 conf)p_statute_title_row__1 was PA Statute TitleRow1 (0.34 conf)section_row__1 was SectionRow1 (0.27 conf)subsection_row__1 was SubsectionRow1 (0.45 conf)statute_description_row__1 was Statute DescriptionRow1 (0.35 conf)counts_row__1 was CountsRow1 (0.45 conf)grade_row__1 was GradeRow1 (0.31 conf)disposition_row__1 was DispositionRow1 (0.46 conf)p_statute_title_row__2 was PA Statute TitleRow2 (0.34 conf)section_row__2 was SectionRow2 (0.27 conf)subsection_row__2 was SubsectionRow2 (0.45 conf)statute_description_row__2 was Statute DescriptionRow2 (0.35 conf)counts_row__2 was CountsRow2 (0.45 conf)grade_row__2 was GradeRow2 (0.31 conf)disposition_row__2 was DispositionRow2 (0.46 conf)p_statute_title_row__3 was PA Statute TitleRow3 (0.34 conf)section_row__3 was SectionRow3 (0.27 conf)subsection_row__3 was SubsectionRow3 (0.45 conf)statute_description_row__3 was Statute DescriptionRow3 (0.35 conf)counts_row__3 was CountsRow3 (0.45 conf)grade_row__3 was GradeRow3 (0.31 conf)disposition_row__3 was DispositionRow3 (0.46 conf)p_statute_title_row__4 was PA Statute TitleRow4 (0.34 conf)section_row__4 was SectionRow4 (0.27 conf)subsection_row__4 was SubsectionRow4 (0.45 conf)statute_description_row__4 was Statute DescriptionRow4 (0.35 conf)counts_row__4 was CountsRow4 (0.45 conf)grade_row__4 was GradeRow4 (0.31 conf)disposition_row__4 was DispositionRow4 (0.46 conf)p_statute_title_row__5 was PA Statute TitleRow5 (0.34 conf)section_row__5 was SectionRow5 (0.27 conf)subsection_row__5 was SubsectionRow5 (0.45 conf)statute_description_row__5 was Statute DescriptionRow5 (0.35 conf)counts_row__5 was CountsRow5 (0.45 conf)grade_row__5 was GradeRow5 (0.31 conf)disposition_row__5 was DispositionRow5 (0.46 conf)reason_expungement was ReasonForExpungement (0.47 conf)reason_missing_history was ReasonForMissingHistory (0.43 conf)date_sig was Date of Sig (0.34 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
county__1county__2md_j_number
Suggested Screen 1:
Suggested Screen 2:
docket_seg__1docket_seg__2docket_seg__3docket_seg__4cp_docket_number
Suggested Screen 3:
Suggested Screen 4:
addr__1addr__2judge_addr__1judge_addr__2affiant_addr__1affiant_addr__2
Suggested Screen 5:
aliases__1aliases__2aliases__3aliases__4aliases__5
Suggested Screen 6:
Suggested Screen 7:
addr_cityjudge_addr_cityjudge_addr_state
Suggested Screen 8:
defendantdate_arrestdate_complaint
Suggested Screen 9:
Suggested Screen 10:
addr_stateaffiant_addr_cityaffiant_addr_state
Suggested Screen 11:
addr_zipjudge_addr_zipaffiant_addr_zip
Suggested Screen 12:
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Suggested Screen 13:
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Suggested Screen 14:
grade_row__1grade_row__2grade_row__3grade_row__4grade_row__5
Suggested Screen 15:
disposition_row__1disposition_row__2disposition_row__3disposition_row__4disposition_row__5
Suggested Screen 16:
subsection_row__1counts_row__1subsection_row__2counts_row__2subsection_row__3counts_row__3subsection_row__4counts_row__4subsection_row__5counts_row__5
Suggested Screen 17:
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