____________________________________________________________________________________________________________________________________________________________________ PETITION TO SEAL COURT / ARREST RECORDS Revised 2/08/2024 L-500 www.occourts.org Pen. Code §§ 851.90, 851.91 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address.) Telephone No.: Bar No. E-mail address: ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Drive West, Santa Ana, CA Harbor - 4601 Jamboree Road, Newport Beach, CA North - 1275 N.

Berkeley Avenue, Fullerton, CA West - 8141 13th Street, Westminster, CA PEOPLE OF THE STATE OF CALIFORNIA VS. DEFENDANT: PETITION TO SEAL COURT / ARREST RECORDS CASE NUMBER Note to Petitioner: Arrests that happened on or after January 1, 1973 may qualify for automatic arrest record relief if they did not result in a conviction and meet certain other conditions. (Pen. Code § 851.93.) A petition to seal may be unnecessary if automatic relief has been granted. To find out if automatic relief was granted, request your Record of Arrest and Prosecution (RAP) sheet from the California Department of Justice.

Failing to check, however, does not prevent you from filing this petition. The petition must be completed in its entirety and served upon the Prosecuting Attorney and Arresting Agency prior to filing with the court. Hearing date and department must be set in accordance with court guidelines. 1. The petition will be heard on ______________ at ________ in Department __________ at the address listed above. 2.

Information relating to the arrest / filing: Last First Middle Name: Date of Birth: Driver’s License No: Date of Arrest: Arresting Agency: City and County of Arrest City: County: Booking Number: Police Report Number: Charge(s): 3. I am entitled to have my arrest sealed as a matter of right: a. No complaint was filed. The statute of limitations has run on every offense upon which the arrest was based and the prosecutor has not filed an accusatory pleading based on the arrest. b. A complaint was filed. The charges have been dismissed and charges may not be refiled. c. A complaint was filed.

No conviction occurred and I have been acquitted of all charges. d. Pursuant to Penal Code § 1000.4 & 1001.9. 4. I am requesting that my arrest be sealed in the interest of justice for the reasons noted below: (Continued on next page) ____________________________________________________________________________________________________________________________________________________________________ PETITION TO SEAL COURT / ARREST RECORDS Revised 2/08/2024 L-500 www.occourts.org Pen.

Code §§ 851.90, 851.91 Case Name: Case Number: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATE TYPE OR PRINT NAME SIGNATURE OF PETITIONER DATE TYPE OR PRINT NAME OF ATTORNEY SIGNATURE OF ATTORNEY ____________________________________________________________________________________________________________________________________________________________________ PETITION TO SEAL COURT / ARREST RECORDS Revised 2/08/2024 L-500 www.occourts.org Pen. Code §§ 851.90, 851.91 Case Name: Case Number: PROOF OF SERVICE Personal Service Service by Mail 1.

Person serving: I am over the age of and not a party to this action. Name: Address: Telephone: 2. I served a copy of the Petition and Order to Seal and Destroy Arrest Records as follows (check one): a. Personal Service: I personally delivered the Petition and Order to Seal and Destroy Arrest Records to the person at the address listed below:

(1) Law Enforcement Agency:

(2) Address where served:

(3) Date served:

(4) Time served: b. Service by Mail: I deposited the Petition and Order to Seal and Destroy Arrest Records in the United States mail, in a sealed envelope with first class postage fully prepaid. The envelope was addressed as follows:

(1) Law Enforcement Agency:

(2) Address:

(3) Date of Mailing:

(4) Place of Mailing (city and state): 3. I served a copy of the Petition and Order to Seal and Destroy Arrest Records as follows (check one): a. Personal Service: I personally delivered the Petition and Order to Seal and Destroy Arrest Records to the person at the address listed below:

(1) Name of person served: Office of the District Attorney Office of the City Attorney

(2) Address where served:

(3) Date served:

(4) Time served: b. Service by Mail: I deposited the Petition and Order to Seal and Destroy Arrest Records in the United States mail, in a sealed envelope with first class postage fully prepaid. The envelope was addressed as follows:

(1) Name of person served: Office of the District Attorney Office of the City Attorney

(2) Address:

(3) Date of Mailing:

(4) Place of Mailing (city and state): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: TYPE OR PRINT NAME SIGNATURE OF DECLARANT