Form 0000RCCD-005 "Dna Expungement Application" - Nevada

What Is Form 0000RCCD-005?

This is a legal form that was released by the Nevada Department of Public Safety - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Nevada Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 0000RCCD-005 by clicking the link below or browse more documents and templates provided by the Nevada Department of Public Safety.

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Download Form 0000RCCD-005 "Dna Expungement Application" - Nevada

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Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6200 ~ Fax (775) 687-3419
www.rccd.nv.gov
DNA EXPUNGEMENT APPLICATION
REQUEST TO THE CENTRAL REPOSITORY OF NEVADA RECORDS OF CRIMINAL HISTORY TO
EXPUNGE MY CODIS AND STATE DNA DATABASE PROFILE AND DESTROY MY SAMPLE
Please the information used at the time of the collection:
First Name:
Middle Name:
Last Name:
Complete Mailing Address:
Social Security Number:
Date of Birth:
Nevada State Identification Number (SID)
Pursuant to NRS 176.09123, if a person is arrested for a felony or certain other specified offenses, the law
enforcement agency making the arrest shall obtain a biological specimen from the person and submit the
biological specimen to the appropriate forensic laboratory for genetic marker analysis.
On or about _____________________________________________(date/year), I provided a DNA sample for inclusion in the
Nevada state DNA database and CODIS (NRS 176.09123) to a law enforcement agency in __________________
_____________________________________(City), under the name I listed above.
To the best of my knowledge, the charge for which my DNA database sample was taken was (describe or
name(s) of charge(s):
I request that my biological specimen be destroyed and the DNA profile and DNA record be purged
from the designated Forensic Laboratory (pursuant to NRS 176.0917), the State DNA Database and
CODIS on the following grounds:
(CHECK ONE AND ATTACH THE DOCUMENTATION DESCRIBED)
A. The arrest/conviction which formed the basis of my DNA collection has been resolved by:
1. A dismissal — The felony charge(s) which formed the basis of my DNA collection was dismissed.
[Attach a certified copy of the court docket or minute order dismissing the charge(s), or a trial
court’s Clerk Certificate verifying this fact.]
2. Successful completion of a pre-prosecution diversion program [Attach a certified copy of the
court docket or minute order making this ruling.]
3. Conditional discharge [Attach a certified copy of the conditional discharge]
0000RCCD-005(06/2019rev)
DNA Expungement Application
Page 1 of 2
Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6200 ~ Fax (775) 687-3419
www.rccd.nv.gov
DNA EXPUNGEMENT APPLICATION
REQUEST TO THE CENTRAL REPOSITORY OF NEVADA RECORDS OF CRIMINAL HISTORY TO
EXPUNGE MY CODIS AND STATE DNA DATABASE PROFILE AND DESTROY MY SAMPLE
Please the information used at the time of the collection:
First Name:
Middle Name:
Last Name:
Complete Mailing Address:
Social Security Number:
Date of Birth:
Nevada State Identification Number (SID)
Pursuant to NRS 176.09123, if a person is arrested for a felony or certain other specified offenses, the law
enforcement agency making the arrest shall obtain a biological specimen from the person and submit the
biological specimen to the appropriate forensic laboratory for genetic marker analysis.
On or about _____________________________________________(date/year), I provided a DNA sample for inclusion in the
Nevada state DNA database and CODIS (NRS 176.09123) to a law enforcement agency in __________________
_____________________________________(City), under the name I listed above.
To the best of my knowledge, the charge for which my DNA database sample was taken was (describe or
name(s) of charge(s):
I request that my biological specimen be destroyed and the DNA profile and DNA record be purged
from the designated Forensic Laboratory (pursuant to NRS 176.0917), the State DNA Database and
CODIS on the following grounds:
(CHECK ONE AND ATTACH THE DOCUMENTATION DESCRIBED)
A. The arrest/conviction which formed the basis of my DNA collection has been resolved by:
1. A dismissal — The felony charge(s) which formed the basis of my DNA collection was dismissed.
[Attach a certified copy of the court docket or minute order dismissing the charge(s), or a trial
court’s Clerk Certificate verifying this fact.]
2. Successful completion of a pre-prosecution diversion program [Attach a certified copy of the
court docket or minute order making this ruling.]
3. Conditional discharge [Attach a certified copy of the conditional discharge]
0000RCCD-005(06/2019rev)
DNA Expungement Application
Page 1 of 2
4. Acquittal — I was acquitted or found not guilty of the offense which qualified me for inclusion in
the Nevada state DNA database and CODIS. [Attach a certified copy of the court docket or minute
order making this finding.]
5. An agreement entered into by a prosecuting attorney and the defendant in which the defendant,
in exchange for a plea of guilty, guilty but mentally ill, or nolo contendere, received a charge other
than a felony. [Attach a certified copy of the court minutes]
B.
No qualifying charges were or will be filed within three (3) years after the date of arrest. [Attach
sworn affidavit from the arresting law enforcement agency, providing case name and number, and
certifying that no charge(s) will be filed based on the arrest or attach a certified copy of a complaint
reflecting that only misdemeanor charge(s) were filed based on the arrest.]
I certify to the best of my knowledge that all of the following statements are true:
A. I have no past or present criminal offense that qualifies me for inclusion in the Nevada state DNA
database and CODIS.
[Note: (1) If you provided a DNA sample after you were validly convicted of a felony, the fact you subsequently had
that felony conviction expunged (NRS 179.245, 176A.265, 179.259 and 453.3365), or reduced to a misdemeanor, does
not entitle you to also have your DNA profile expunged or sample removed from the Nevada state DNA database and
CODIS. (2) If you provided a DNA sample after a conviction for a misdemeanor and had any past felony conviction at
that time, your sample is not eligible for expungement or removal from the Nevada state DNA database and CODIS.]
B. I have no past or present duty to register as a sex offender. [NRS 179D.445, 179D.460 or 179D.480]
C. I did not provide a DNA sample as a part of a plea bargain.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on:
at
, State of
(Date)
(City)
(State)
Print Name:
Signature:
(person requesting DNA profile expungement and sample removal)
Mail the completed from to:
Central Repository of Nevada Records of Criminal History
Attn: Fingerprint Support – Criminal Unit
333 West Nye Lane #100
Carson City, Nevada 89706
For State Repository Use Only
For Forensic Laboratory Use Only
Received Date:
Received Date:
Received By:
Received By:
Washoe County
Las Vegas
Granted
Denied
Sent to Forensic Lab:
Expungement:
Date Sent to Lab:
Expungement Date:
Sent by:
Date State Notified:
0000RCCD-005(06/2019rev)
DNA Expungement Application
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