Art. 989. Motion for expungement forms to be used
STATE OF LOUISIANA
JUDICIAL DISTRICT FOR THE PARISH OF
______________________________
No.: _____________Division: "_______"
State of Louisiana
vs.
_______________________________________________________
MOTION FOR EXPUNGEMENT
NOW INTO COURT comes mover, who provides the court with the following
information in connection with this request:
I.DEFENDANT INFORMATION
NAME: ___________________________________________________________
(Last, First, MI)
DOB: ________/______/_______ (MM/DD/YYYY)
GENDER _____ Female _____Male
SSN (last 4 digits): XXX-XX-________
RACE: _________________
DRIVER LIC.# _________________
ARRESTING AGENCY: __________________________________________
SID# (if available): _________________
ARREST NUMBER (ATN): _________________
AGENCY ITEM NO. _________________
Mover is entitled to expunge the record of his arrest/conviction pursuant to Louisiana
Code of Criminal Procedure Article 971 et seq. and states the following in support:
II.ARREST INFORMATION
1. Mover was arrested on _______/______/_______ (MM/DD/YYYY)
2. _____ YES _____ NO A supplemental sheet with arrests and/or
convictions is attached after page 2 of this
Motion.
3. Mover was:
_____ YES _____ NO Arrested, but it did not result in conviction
_____ YES _____ NO Convicted of and seeks to expunge a
misdemeanor
_____ YES _____ NO Convicted of and seeks to expunge a felony
_____ YES _____ NO Convicted but determined to be factually
innocent and entitled to compensation for a
wrongful conviction pursuant to the
provisions of R.S. 15:572.8.
4. Mover was booked and/or charged with the following offenses: (List each
offense booked and charged separately. Attach a supplemental sheet, if
necessary.)
____ Yes ____ No ARRESTS THAT DID NOT RESULT IN CONVICTION
NO. 1 La. Rev. Stat. Ann. § _______ : ________
Name of the offense __________________
( ) Time expired for prosecution__________________
(MM/DD/YYYY)
( ) Not prosecuted for any offense
arising out of this charge.
( ) Pre-trial Diversion Program.
( ) DWI Pre-Trial Diversion Program
and 5 years have elapsed since the
date of arrest.
( ) Charge dismissed
( ) Found not guilty/judgment of acquittal
NO. 2 La. Rev. Stat. Ann. § _______ : ________
Name of the offense __________________
( ) Time expired for prosecution__________________
(MM/DD/YYYY)
( ) Not prosecuted for any
offense arising out of this charge.
( ) Pre-trial Diversion Program.
( ) Charge dismissed
( ) Found not guilty/judgment of acquittal
NO. 3 La. Rev. Stat. Ann. § _______ : ________
Name of the offense __________________
( ) Time expired for prosecution__________________
(MM/DD/YYYY)
( ) Not prosecuted for any offense
arising out of this charge.
( ) Pre-trial Diversion Program.
( ) Charge dismissed
( ) Found not guilty/judgment of acquittal
____ Yes ____ No MISDEMEANOR CONVICTIONS
NO. 1 La. Rev. Stat. Ann. § _______ : ________
Name of the offense _________________
( ) Conviction set aside/dismissed _____/____/_______
pursuant to C.Cr.P. Art. 894(B) (MM/DD/YYYY)
( ) More than 5 years have passed
since completion of sentence.
NO. 2 La. Rev. Stat. Ann. § _______ : ________
Name of the offense _________________
( ) Conviction set aside/dismissed _____/____/_______
pursuant to C.Cr.P. Art. 894(B) (MM/DD/YYYY)
( ) More than 5 years have passed
since completion of sentence.
____ Yes ____ No FELONY CONVICTIONS
NO. 1 La. Rev. Stat. Ann. § _______ : ________
( ) Conviction set aside/dismissed _____/____/_______
pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)
( ) More than 10 years have passed
since completion of sentence
( ) Received a first offender pardon for an eligible offense
NO. 2 La. Rev. Stat. Ann. § _______ : ________
( ) Conviction set aside/dismissed _____/____/_______
pursuant to C.Cr.P. Art. 893(E)(MM/DD/YYYY)
( ) More than 10 years have passed
since completion of sentence
( ) Received a first offender pardon for an eligible offense
____ Yes ____ No OPERATING A MOTOR VEHICLE WHILE
INTOXICATED CONVICTIONS
Mover has attached the following:
( ) A copy of the proof from the Department of Public Safety and
Corrections, office of motor vehicles, that it has received from the
clerk of court a certified copy of the record of the plea, fingerprints of
the defendant, and proof of the requirements set forth in C.Cr.P. Art.
556, which shall include the defendant's date of birth, last four digits
of social security number, and driver's license number
5. Mover has attached to this Motion the following pertinent documents:
□ Criminal Background Check from the La. State Police/Parish Sheriff
dated within the past 60 days (required).
□ Bill(s) of Information (if any).
□ Minute entry showing final disposition of case (if any).
□ Certification Letter from the District Attorney for fee waiver (if
eligible).
□ Certification Letter from the District Attorney verifying that the
applicant has no convictions or pending applicable criminal charges
in the requisite time periods.
□ Certification Letter from the District Attorney verifying that the
charges were refused.
□ Certification Letter from the District Attorney verifying that the
applicant did not participate in a pretrial diversion program.
□ A copy of a first offender pardon.
□ A copy of the order waiving the sex offender registration and
notification requirements.
□ A copy of the court order determination of factual innocence and
order of compensation for a wrongful conviction pursuant to the
provisions of R.S. 15:572.8 if applicable.
The Mover prays that if there is no objection timely filed by the arresting law
enforcement agency, the district attorney's office, or the Louisiana Bureau of Criminal
Identification and Information, that an order be issued herein ordering the expungement of
the record of arrest and/or conviction set forth above, including all photographs, fingerprints,
disposition, or any other such information, which record shall be confidential and no longer
considered a public record, nor be made available to other persons, except a prosecutor,
member of a law enforcement agency, or a judge who may request such information in
writing, certifying that such request is for the purpose of prosecuting, investigating, or
enforcing the criminal law, for the purpose of any other statutorily defined law enforcement
or administrative duties, or for the purpose of the requirements of sex offender registration
and notification pursuant to the provisions of R.S. 15:541 et seq. or as an order of this Court
to any other person for good cause shown, or as otherwise authorized by law.
If an "Affidavit of No Opposition" by each agency named herein is attached hereto
and made a part hereof, Defendant requests that no contradictory hearing be required and the
Motion be granted ex parte.
Respectfully submitted,
____________________________________
Signature of Attorney for Mover/Defendant
____________________________________
Attorney for Mover/Defendant Name
____________________________________
Attorney's Bar Roll No.
____________________________________
Address
____________________________________
City, State, ZIP Code
____________________________________
Telephone Number
If not represented by counsel:
____________________________________
Signature of Mover/Defendant
____________________________________
Mover/Defendant Name
____________________________________
Address
____________________________________
City, State, ZIP Code
____________________________________
Telephone Number
Acts 2014, No. 145, §1; Acts 2015, No. 200, §1; Acts 2016, No. 125, §1, eff. May
19, 2016; Acts 2018, No. 711, §1; Acts 2020, No. 71, §1; Acts 2020, No. 73, §1.