STATE OF LOUISIANA VS ________________

: _______ JUDICIAL DISTRICT COURT : PARISH OF _______, LOUISIANA : DOCKET NO. _______

_________________________________________________________________________________ MOTION AND ORDER TO EXPUNGE ARREST RECORD PURSUANT TO LSA 44:9 NOW INTO COURT comes ________________, Defendant herein, who respectfully represents the following: I. Your Defendant was arrested on _______ ___, 20___, and charged with the crime of ________________. II. Subsequent to your Defendant=s arrest, the charges of ________________ were dismissed by the District Attorney on _______ ___, 20___. A certified copy of the minutes is attached as Exhibit AA@. III. That pursuant to LSA R.S. 44:9, your Defendant is requesting an expungement of his arrest record as it relates to the charge of ________________ as it is prohibiting him from pursuing certain personal and work-related activities. WHEREFORE, your Defendant prays that the _______ Parish Sheriff and the State of Louisiana, through the Office of the District Attorney for the Parish of _______ show cause on the ____ day of ____________ 20___, at _____ o=clock ___.M. why this Motion should not be granted, ordering any and all law enforcement agencies to expunge his record according to LSA R.S. 44:9. Respectfully Submitted, __________________________ ________________ Attorney for Defendant ________________ _______, LA _______ (___)_______ LA. Bar Roll No. _______

STATE OF LOUISIANA VS ________________

: _______ JUDICIAL DISTRICT COURT : PARISH OF _______, LOUISIANA : DOCKET NO. _______

_________________________________________________________________________________ ORDER When, after reviewing the pleadings filed herein, the testimony and evidence offered, the Court finds the law and evidence are in favor of Defendant, ________________. IT IS HEREBY ORDERED, ADJUDGED AND DECREED that the _______ Parish Sheriff and the State of Louisiana, through the Office of the District Attorney for the Parish of _______ show cause on the _____ day of ______________ 20___, at ______ o=clock ___.M. why the aforesaid Motion should not be granted ordering all law enforcement agencies, including the Louisiana State Police to expunge the arrest record of ________________, date of birth, _______ ___, _____, Social Security No. ________________, pursuant to LSA 44:9, et seq. IT IS FURTHER ORDERED, ADJUDGED AND DECREED that Defendant, ________________, pay all costs of Court. SIGNED in __________, _______ Parish, Louisiana, on this ______ day of __________________ 20___.

_____________________________ DISTRICT JUDGE PLEASE SERVE: _______ Parish Sheriff __________, LA _______ _______ Parish District Attorney _______ Parish Courthouse __________, LA _______ _______ Parish Clerk of Court _______ Parish Courthouse __________, LA _______