JUDICIAL DISTRICT FOR THE PARISH OF | ||
______________________________ | ||
No.: _____________ | Division: " _______ " | |
State of Louisiana | ||
vs. | ||
_______________________________________________________ |
ORDER OF EXPUNGEMENT UNDER CODE OF CRIMINAL PROCEDURE ARTICLE 999
Pursuant to Code of Criminal Procedure Article 999, wherein all of the following applies,
IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that the following charges and arrest on the dates provided herein be expunged.
THUS ORDERED AND SIGNED, ADJUDGED, AND DECREED this
____ day of _________________, 20 ____ at ______________, Louisiana,
___________________________.
___________________________
JUDGE
DEFENDANT INFORMATION:
NAME: ________________________________________________
First | Middle | Last |
DATE OF BIRTH: _____________ | ||
GENDER: _____________ | ||
SS# ___________________________ | ||
RACE ___________________________ | ||
DRIVERS LICENSE# ___________________ | ||
ARRESTING AGENCY ___________________ | ||
SID# ___________________ | ||
ARREST NUMBER (ATN) ___________________ | ||
AGENCY ITEM NO: ________________________ | ||
PLEASE SERVE: | ||
1. District Attorney: ________________________________________________ | ||
2. Arresting Agency: _______________________________________________ | ||
3. Parish Sheriff: _______________________________________ | ||
4. Louisiana Bureau of Criminal Identification and Information ____________________________ | ||
5. Attorney for Defendant (or defendant) ____________________________ | ||
6. Clerk of Court ____________________________ |
_______________________________________
SPEAKER OF THE HOUSE OF REPRESENTATIVES
_______________________________________
PRESIDENT OF THE SENATE
_______________________________________
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: __________
La. Cr.P. § 999.1