Sealing Criminal Record / Expungement Intake Form

BY CHECKING THIS BOX, I ACKNOWLEDGE THAT INDIANA XP DOES NOT CLEAR MURDER CONVICTIONS. IN ADDITION, I ALSO KNOWLEDGE THE ATTACHED DOCUMENTATION DETAILING CRIMES THAT CANNOT BE EXPUNGED IN THE STATE OF INDIANA.
CLICK HERE TO ACKNOWLEDGE OUR FULL LISTING


WE CANNOT PROCESS YOUR CASE WITHOUT THIS INFORMATION. IF YOU DO NOT KNOW THE EXACT DATE OF YOUR CONVICTION, PLEASE PROVIDE A DATE RANGE OR PERIOD.

THIS INFORMATION WILL BE USED TO DETERMINE YOUR ELIGIBILITY TO HAVE YOUR CRIMINAL RECORD SEALED AND/OR YOUR CONVICTION(S) EXPUNGED. PLEASE ANSWER ALL THE QUESTIONS YOU CAN.  IF YOU DO NOT KNOW THE ANSWER TO A QUESTION, PLEASE LEAVE THE SECTION BLANK.

 

Client Personal Information
 
 
Criminal Record Questions
 
10. ARE YOU CURRENTLY PARTICIPATING IN A PRE-TRIAL DIVERSION PROGRAM?
11. DO YOU HAVE ANY CRIMINAL CHARGES PENDING AGAINST YOU?
12. WAS ANYONE INJURED/KILLED AS A RESULT OF YOUR CRIME?
13. HAVE YOU EVER FILED TO SEAL YOUR CONVICTION RECORD/EXPUNGE YOUR CONVICTIONS BEFORE?
14. HAVE YOU BEEN ARRESTED IN ANY STATE OTHER THAN INDIANA?

IF YES, STATE THE CAUSE, CASE NUMBER, CITY, COUNTY AND STATE OF ARREST

15. WERE YOU ORDERED TO PAY RESTITUTION, FINES, AND/OR COURT COSTS AS PART OF YOUR SENTENCE?
 
16. WAS YOUR FELONY CONVICTION REDUCED FROM A FELONY TO A MISDEMEANOR?
17. ARE YOU SEEKING RESTORATION OF FIREARMS RIGHTS? IF SO, AN ADDITIONAL FEE OF $250.00 WILL BE ADDED.

 



I HEREBY SWEAR AND AFFIRM THAT THIS QUESTIONNAIRE IS A TRUE AND ACCURATE LIST OF MY ENTIRE CRIMINAL HISTORY AND THERE ARE NO OTHER CONVICTIONS, CHARGES AND/OR ARRESTS I AM AWARE OF AT THIS TIME. 

 
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