Form JD-JM-12 "Erasure of Record/Petition/Order" - Connecticut

What Is Form JD-JM-12?

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

Form Details:

  • Released on October 1, 2015;
  • The latest edition provided by the Connecticut Superior Court;
  • 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 fillable version of Form JD-JM-12 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-JM-12 "Erasure of Record/Petition/Order" - Connecticut

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ERASURE OF RECORD
STATE OF CONNECTICUT
PETITION/ORDER
SUPERIOR COURT
JUVENILE MATTERS
JD-JM-12 Rev. 10-15
C.G.S. §§ 46b-120; 46b-133a; 46b-146
www.jud.ct.gov
P.A. 15-195 § 3
P.B. §§ 27-4(A); 27-8A(c); 27-9(c)
ADA Notice
Instructions To Person Asking To Have Record Erased
The
Judicial
Branch
of
the
State
of
Complete Section I below, sign it in front of a notary public, an assistant
Connecticut complies with the Americans
clerk of the Superior Court, or a Commissioner of the Superior Court,
with Disabilities Act (ADA). If you need a
and file the original with the court. Keep a copy for yourself.
reasonable accommodation in accordance
Instructions To Court Staff
with the ADA, contact a court clerk or an ADA
Send a copy of the signed order to all depositories of police and court records pertaining
contact person listed at www.jud.ct.gov/ADA.
to the charge of delinquency or that a child is from a family with service needs.
Address of Court
Docket Number
Name of Child
Date of Birth
Date of Disposition/Discharge
Police Department
Police Department Case Number
Section 1 — Petition For Erasure Of Record
I respectfully request that the court erase all police and court records about the child named above.
I swear to the following facts:
At least 2 (two) years or, in the case of a serious juvenile offense conviction, 4 (four) years have passed
• from the date the child was discharged from the supervision of the Superior Court or
• the child was discharged from the custody of the Department of Children and Families or
• the child was discharged from the care of any other institution or agency the child was admitted to by the court
and
• no other juvenile proceeding or adult criminal proceeding is pending against the child, and
• the child has not been convicted of a delinquent act that would constitute a felony or misdemeanor if committed by an adult
during the 2 year or 4 year period, and
• the child has not been convicted as an adult of a felony or misdemeanor during the 2 year or 4 year period, and
• that the child has reached age 18.
OR
The child has a record because of being a victim of trafficking.
I request a hearing in order to show that there is good cause to erase the records before the statutorily required time period expires.
Date of Petition
Address of Petitioner
Signed (Petitioner (Child/Parent/Guardian, or Attorney))
Date
Signed (Notary Public, Assistant Clerk, Commissioner of the Superior Court )
Subscribed and
Sworn to before me:
Granted, all police and court records about the child are erased under section 46b-146 of the General Statutes.
Denied.
By the Court (Print or type name of Judge)
Date Signed
Signed (Judge/Clerk/Assistant Clerk)
Print Form
Reset Form
ERASURE OF RECORD
STATE OF CONNECTICUT
PETITION/ORDER
SUPERIOR COURT
JUVENILE MATTERS
JD-JM-12 Rev. 10-15
C.G.S. §§ 46b-120; 46b-133a; 46b-146
www.jud.ct.gov
P.A. 15-195 § 3
P.B. §§ 27-4(A); 27-8A(c); 27-9(c)
ADA Notice
Instructions To Person Asking To Have Record Erased
The
Judicial
Branch
of
the
State
of
Complete Section I below, sign it in front of a notary public, an assistant
Connecticut complies with the Americans
clerk of the Superior Court, or a Commissioner of the Superior Court,
with Disabilities Act (ADA). If you need a
and file the original with the court. Keep a copy for yourself.
reasonable accommodation in accordance
Instructions To Court Staff
with the ADA, contact a court clerk or an ADA
Send a copy of the signed order to all depositories of police and court records pertaining
contact person listed at www.jud.ct.gov/ADA.
to the charge of delinquency or that a child is from a family with service needs.
Address of Court
Docket Number
Name of Child
Date of Birth
Date of Disposition/Discharge
Police Department
Police Department Case Number
Section 1 — Petition For Erasure Of Record
I respectfully request that the court erase all police and court records about the child named above.
I swear to the following facts:
At least 2 (two) years or, in the case of a serious juvenile offense conviction, 4 (four) years have passed
• from the date the child was discharged from the supervision of the Superior Court or
• the child was discharged from the custody of the Department of Children and Families or
• the child was discharged from the care of any other institution or agency the child was admitted to by the court
and
• no other juvenile proceeding or adult criminal proceeding is pending against the child, and
• the child has not been convicted of a delinquent act that would constitute a felony or misdemeanor if committed by an adult
during the 2 year or 4 year period, and
• the child has not been convicted as an adult of a felony or misdemeanor during the 2 year or 4 year period, and
• that the child has reached age 18.
OR
The child has a record because of being a victim of trafficking.
I request a hearing in order to show that there is good cause to erase the records before the statutorily required time period expires.
Date of Petition
Address of Petitioner
Signed (Petitioner (Child/Parent/Guardian, or Attorney))
Date
Signed (Notary Public, Assistant Clerk, Commissioner of the Superior Court )
Subscribed and
Sworn to before me:
Granted, all police and court records about the child are erased under section 46b-146 of the General Statutes.
Denied.
By the Court (Print or type name of Judge)
Date Signed
Signed (Judge/Clerk/Assistant Clerk)
Print Form
Reset Form
Section 2 — Order For Erasure By Operation Of Law
Under the provisions of section 46b-146 of the Connecticut General Statutes
The charge(s)
of delinquency
that a family is a family with service needs (FWSN)
arising out of the petition(s)/information(s) in the matter of the child named above was (were) dismissed.
Under the provisions of section 46b-133a(b) of the Connecticut General Statutes
The child named above was charged with delinquency and 13 months have elapsed since:
a nolle prosequi has been entered as to the charge(s) in the petition(s)/information(s)
OR
the charge(s) in the petition(s)/information(s) has/have been dismissed without prejudice.
Under the provisions of section 27-8A(c) of the Connecticut Practice Book the child has successfully completed nonjudicial
delinquency handling and the matter is dismissed and erased for all purposes except later consideration for nonjudicial handling under
section 27-4A of the Connecticut Practice Book.
Under the provisions of section 27-9(c) of the Connecticut Practice Book the child has successfully completed a diversion to FWSN
services under section 46b-149(g) of the Connecticut General Statutes and the matter is dismissed and erased for all purposes
except subsequent consideration for nonjudicial handling under section 27-4A of the Connecticut Practice Book.
Now, therefore, it is ordered that all police and court records pertaining to such charge(s) are erased.
By the Court (Print or type name of Judge)
On (Date)
Date Signed
Signed (Judge/Clerk/Assistant Clerk)
Notice to Depositories of Police and Court Records
Upon the entry of such an erasure order, all references including arrest, complaint, referrals, petitions, reports and orders shall be
removed from all agency, official and institutional files, and a finding of delinquency or that the child was a member of a family with
service needs shall be deemed never to have occurred. The persons in charge of such records shall not disclose to any person
information pertaining to the record so erased, except that the fact of such erasure may be substantiated where, in the opinion of
the court, it is in the best interests of such child to do so.
Print Form
Reset Form
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