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Here is the text we could read:

COMMONWEALTH OF PENNSYLVANIA 
COUNTY OF 

Commonwealth of Pennsylvania
v.

__________________________________

Docket No: _________________________

          And NOW, the applicant avers the following and requests that this petition for expungement pursuant to 24 P.S. 
§13-1333.3 be granted for the reasons set forth below.

Petition for Expungement Pursuant to 24 P.S. § 13-1333.3

Full Name:

Address:

PETITIONER'S INFORMATION

 DOB:

Alias(es): 

Social Security Number:

List name and address of Judge of the Magisterial District or Philadelphia Municipal Court who accepted the guilty plea or heard the case:

Judge:

Magisterial District Court Number:

Philadelphia Municipal Court or Magisterial District Docket Number:

CASE INFORMATION

 Address:

Name of Arresting Agency:

 Date of Arrest:

 Date on Citation or Complaint:

List name and mailing address of the affiant as shown on the complaint or citation, if available:

Name of Affiant:

 Address:

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):

Pa.Statute
(Title)

   Section

 Subsection Statute Description

Counts Grade Disposition

If the sentence imposed included a fine or costs, has the amount due been paid?

Yes

No

List the reason(s) for the expungement (please attach additional sheets of paper if necessary):

        A copy of the petitioner's high school diploma, a Commonwealth secondary school diploma, or another Department of 
Education-approved equivalent, or documentation that the applicant is subject to an exception to compulsory attendance 
under 24 P.S § 13-1330 is attached to the application.

When this petition is filed, the applicant shall serve a copy upon the affiant or the attorney for the Commonwealth.
      I, the undersigned petitioner, aver that I have satisfied the requirements of 24 P.S. § 13-1333.3(h) for expungement.
      I, the undersigned petitioner, aver that the facts set forth in this application 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.
       I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that 
require filing confidential information and documents differently than non-confidential information and documents.

Signature of Petitioner

Date

CPCMS 102

1

(Untitled)

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): 68
Average fields per page: 68
Reading Level: Grade 10
LIST Grouping(s): Unknown

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.

docket was Docket No (0.54 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)
judge was Judge (0.39 conf)
district_court_number was Magisterial District Court Number (0.39 conf)
name_arresting_agency was Name of Arresting Agency (0.44 conf)
name_affiant was Name of Affiant (0.39 conf)
pa_statute_title_row__1 was PaStatute TitleRow1 (0.43 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)
pa_statute_title_row__2 was PaStatute TitleRow2 (0.43 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)
pa_statute_title_row__3 was PaStatute TitleRow3 (0.43 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)
pa_statute_title_row__4 was PaStatute TitleRow4 (0.43 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)
pa_statute_title_row__5 was PaStatute TitleRow5 (0.43 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)
signature_date was Date (1.00 conf)
defendant was Defendant (1.00 conf)
county was County of (0.41 conf)
users1_name was full name (1.00 conf)
users1_birthdate was DOB (1.00 conf)
social_security_number was Social Security Number (0.38 conf)
md_j_pm_c_docket was MDJ/PMC Docket # (0.30 conf)
date_arrest was date of arrest (0.47 conf)
date_citation was date of citation (0.38 conf)
disp_row__1 was DispRow1 (0.37 conf)
disp_row__2 was DispRow2 (0.37 conf)
disp_row__3 was DispRow3 (0.37 conf)
disp_row__4 was DispRow4 (0.37 conf)
disp_row__5 was DispRow5 (0.37 conf)
reason_exp was reason for exp (0.38 conf)
check_box was check box 2 (0.27 conf)
users1_address_city was city (1.00 conf)
users1_address_state was state (1.00 conf)
users1_address_zip was zip (1.00 conf)
judge_state was judge state (0.43 conf)
judge_zip was judge zip (0.29 conf)
affiant_add was affiant add 1 (0.39 conf)
affiant_city was Affiant city (0.32 conf)
affiant_state was Affiant state (0.46 conf)
affiant_zip was Affiant zip (0.33 conf)
judge_add was judge add 1 (0.36 conf)
judge_city was judge city (0.38 conf)
address was address 1 (0.35 conf)
users1_signature was Signature1 (1.00 conf)

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

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