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IN THE IOWA DISTRICT COURT IN AND FOR _________COUNTY

STATE OF IOWA
CITY OF _________________
Plaintiff
VS
_______________________
Defendant

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Case No. ______________

Defendants Motion for Expungement
of Records Pursuant to Iowa Code
901C.1

COMES NOW Defendant and in support of the Motion for Expungement of

Records under Iowa Code 901C.1, I certify the following to the Court:
1. I was charged with the crime of __________________ under Iowa Code
_____ on the ___ day of __________, ______. The charges were dismissed
or a not guilty verdict was entered on the ___ day of __________, _____.
2. All of the criminal charges in the case were dismissed or there was a verdict
of not guilty on all charges.
3. All costs, fees and other financial obligations ordered by the court or
assessed by the clerk have been paid.
4. At least 180 days have passed since the case was dismissed or since the
verdict of not guilty was entered. If 180 days have not past, I ask the court to
find good cause to waive the 180 day requirement based upon the following
facts and circumstances:
___________________________________________________
5. The dismissal was not based on incompetency to stand trial or a finding of
not guilty by reason of insanity.
6. The case was not related to the grant of a deferred judgment.
7. I have established the necessary conditions of Iowa Code 901C.1 and
request that the Court enter an order expunging the record in this case.
Dated this _______ day of ____________________, 20___.
Respectfully submitted,

Signature of Defendant

________________________________
Defendant (Print Name)
________________________________
Address and City
________________________________
Telephone number
cc: County Attorney or City Attorney