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

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Here is the text we could read:

 
Name 
 
Address 
 
City, State, Zip 
 
Phone 

 
Email 

I am the 

In Re: 

 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  

[  ] Petitioner 
[  ] Attorney for the Petitioner and my Utah Bar number is _________ 

In the [  ] District   [  ] Justice Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

_____________________________________ 
Petitioner 
 

Petition to Expunge Records with 
Special Certificate 
(Utah Code 77-40a-305) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

(What are you trying to expunge? 
 
 

If there was no conviction, complete number 1 and skip number 2. Then go on to number 3. 
If there was a conviction, skip number 1 and complete number 2. Then go on to number 3.) 

1. 

[  ]  Records of crimes without a conviction.  

I was arrested on _________________________ (date) by 

_______________________________________ (law enforcement 

agency). The law enforcement agency’s file number is 

 

 

__________________.  

A court case: 

[  ]  was not filed. 

1001EXF, Approved April 11, 
2022 
 

Petition to Expunge Records with Special Certificate 

Page 1 of 4 

[  ]  was filed as a result of the arrest. It was filed in case number: 

__________________. 

 [  ] The case was dismissed with prejudice. 

 [  ] I was acquitted at trial. 

  

The following apply to me: (choose all that apply) 

[  ]  At least 30 days have passed since I was arrested. 

[  ]  I have not been arrested since this special certificate was issued. 

[  ]  I am not on probation or parole. 

[  ]  There is not a criminal protective order or stalking injunction in 

effect for this case.  

2. 

[  ]  Records of crimes with a conviction. 

 

 

I was convicted of a crime or crimes in court case number. 
________________.  

The following apply to me: (choose all that apply) 

[  ] None of the crimes I am trying to expunge are: 

 a capital or first degree felony; 
 a violent felony as defined in Utah Code 76-3-203.5(1)(c)(i); 
 felony automobile homicide; 
 felony driving under the influence; 
 an offense, or a combination of offenses, that would require me to 
register as a sex offender, as defined in Utah Code 77-41-102 
 a registerable child abuse offense as defined in Utah Code 77-43-

102(2) 

[  ]  There is no criminal case or plea in abeyance pending against me 

or being investigated in any jurisdiction. 

[  ]  I am not on probation or parole.  

[  ]  There is not a criminal protective order or stalking injunction in 

effect for this case.  

[  ] I have not been convicted in separate criminal episodes of: 

 2 or more felonies (other than for drug possession); 
 3 or more crimes (other than for drug possession) of which 2 are 

class A misdemeanors; 

1001EXF, Approved April 11, 
2022 
 

Petition to Expunge Records with Special Certificate 

Page 2 of 4 

 4 or more crimes (other than for drug possession) of which 3 are 

 5 or more crimes (other than for drug possession) of any degree 

class B misdemeanors; or 

other than infractions; 

 3 or more felonies for drug possession; 
 5 or more crimes of any degree for drug possession 

[  ] I have paid all fines, fees, restitution and interest. 

[  ] The following time periods have elapsed from the date I was 

convicted or released from incarceration, probation or parole, 
whichever occurred last: 

 10 years in the case of a misdemeanor conviction of Utah Code 
41-6a-501(2) or a felony conviction of Utah Code 58-37-8(2)(g); 

 7 years in the case of a felony; 
 5 years in the case of a class A misdemeanor or a felony drug 

possession offense; 

 4 years in the case of a class B misdemeanor; or 
 3 years in the case of any other misdemeanor or infraction. 

3. 

Certificate of eligibility.   

BCI was unable to find information about the outcome of my criminal case. BCI 
has issued a special expungement certificate. The identification number for my 
special certificate is: _______________________________. 

I believe I am eligible for expungement because: 

4. 

Public interest.  
Expunging my records will not harm the interests of the public because: 

     

       

1001EXF, Approved April 11, 
2022 
 

Petition to Expunge Records with Special Certificate 

Page 3 of 4 

5. 

Request.  

I ask that the court order expungement of the crimes or alleged crimes identified 
above and order state, county and local government agencies to expunge related 
records in their possession or control. 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

Signature ► 

Printed Name 

 

 

 
Date 

     

1001EXF, Approved April 11, 
2022 
 

Petition to Expunge Records with Special Certificate 

Page 4 of 4

Petition to Expunge Records with Special Certificate

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah 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 legacy.utcourts.gov (2023-03)
Page(s): 4
Fields(s): 106
Average fields per page: 26
Reading Level: Grade 14
LIST Grouping(s): GO-00-00-00-00, CR-00-00-00-00.

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.

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

Petition to Expunge Records with Special Certificate

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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