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In the [  ] District   [  ] Justice Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In Re: 

_____________________________________ 
Petitioner 
 

Order on Petition to Expunge 
Records                                
(Cannabis Conviction) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

The matter before the court is a Petition to Expunge Records. This matter is being 
resolved by:  

[  ]  The pleadings and other papers of the parties, or 

[  ]  A hearing held on ______________________ (date), notice of which was served 
on all parties and at which the court considered the pleadings and evidence 
presented by the parties. 

Having considered the documents filed with the court, the evidence, and the arguments, 
and now being fully informed, 

The court finds by clear and convincing evidence: 
Utah Code 77-40a-306(1)(d) 

1. 

The petition is sufficient. 

1023EXF Approved March 9, 2020 / 
Revised April 11, 2022 
 

Order on Petition to Expunge Records – Cannabis Conviction 

Page 1 of 3 

The statutory requirements have been met. 

At the time of petitioner's arrest or citation leading to the conviction, they had a 
qualifying condition which would have allowed them to use medical cannabis to 
treat symptoms. (Utah Code 26-61a-104).  

At the time of petitioner's arrest or citation leading to the conviction, the cannabis 
in their possession was in a form and amount to medicinally treat their condition. 
(Utah Code 26-61a-102(16) and (32)). 

2. 

3. 

. 

  4

5. 

Expunging the petitioner’s records will not harm the public interest. 

6. 

The records of petitioner’s arrest, investigation, detention, and conviction relating 
to court case number noted above should be expunged. 

The court concludes: 

The court orders: 

•  The records of petitioner’s arrest, investigation, detention, and conviction 

relating to court case number noted above will be expunged. Petitioner may 
deliver a copy of this order to any government agency or official that may 
have such records. 

•  The Bureau of Criminal Identification must notify all criminal justice agencies 

affected by this order.  

Rule 4-205. 

•  The clerk of the court must expunge all related court records as provided by 

•  Any other government agency or official receiving this order must expunge 
related records as provided by Utah Code, Title 77, Chapter 40a, Part 4.  

•  Any government agency or official receiving this order may not divulge 

information identifying the petitioner. 

•  Any government agency or official receiving this order must respond to any 

inquiry as though the arrest or conviction did not occur. 

udge’s signature may instead appear at the top of the first page of this document. 

Signature ► 

 

 

Judge 

  J

 
Date 

1023EXF Approved March 9, 2020 / 
Revised April 11, 2022 
 

Order on Petition to Expunge Records – Cannabis Conviction 

Page 2 of 3 

I certify that I filed with the court and am serving a copy of this Order on Petition to Expunge Records – 
Cannabis Conviction on the following people. 

Certificate of Service 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

Signature ► 

Printed Name 

 

 

(Prosecuting agency) 

 
Date 

 

   

1023EXF Approved March 9, 2020 / 
Revised April 11, 2022 
 

Order on Petition to Expunge Records – Cannabis Conviction 

Page 3 of 3