In the Court of Common Pleas

IN THE COURT OF COMMON PLEAS

JUVENILE COURT DIVISION

LORAIN COUNTY, OHIO

SEALING APPLICATION (O.R.C. 2151.356)

EXPUNGEMENT APPLICATION (O.R.C. 2151.358)

Juvenile’s Name: Case #

Last First M.I.

(Applicant should list name when the juvenile record was obtained even if name is different now)

Date of Birth: Current Age: Social Security #

Current Address:

City, State, Zip Code: Phone: ( ) - -

Has the record(s) already been sealed? Yes No

(A record that has been sealed by the Court will automatically be expunged 5 years after it is sealed or at age 23, whichever is earlier)

The undersigned applicant hereby requests that the applicant’s record be:

Sealed Expunged (record must already be sealed prior to asking for expungement)

The applicant represents that he/she has not been adjudicated delinquent for committing an act that is a violation of Sections 2903.01, 2903.02, 2907.03 or 2907.05 of the Ohio Revised Code states, that the applicant is not currently under the jurisdiction of the court in relation to a delinquency complaint, and that at least two years have passed since the termination of any order made by the Court in relation to the case, or any unconditional discharge from any institution or facility if the applicant was committed to an institution or facility in relation to the case.

The applicant also authorizes the release of any school and/or police report that may aid the court in making a finding in this matter.

The applicant further requests that the record be expunged earlier than the time period for automatic expungement set out in ORC 2151.356 for the following reasons:

Applicant’s Signature ________________________ Date __________________