Form EX-R 2903.4 Request to Expunge & Impound and/Or Seal Criminal Records - Illinois

Form EX-R2903.4 or the "Request To Expunge & Impound And/or Seal Criminal Records" is a form issued by the Illinois Circuit Court.

Download a PDF version of the Form EX-R2903.4 down below or find it on the Illinois Circuit Court Forms website.

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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
REQUEST TO EXPUNGE &
CIRCUIT COURT
IMPOUND AND/OR SEAL
COUNTY
CRIMINAL RECORDS
Instructions
Directly above, enter
Request of:
the name of county
where you will file the
case.
Your name
(First, middle, last name)
Enter your name, birth
date, race, and gender.
List any other names
you used when
Other names used in these cases
arrested on the cases
listed on this form.
Date of birth
Race
Gender
Case Number
(if the Clerk
If the Clerk gave you a
assigns a new number)
new case number,
enter it to the right.
Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County:
Enter the number for
all eligible arrests and
charges on your
criminal record in this
county. If an arrest did
not result in formal
charges, enter the
arrest number.
IF YOU ARE ONLY
1.
I am requesting to expunge and impound records.
REQUESTING TO
Yes
No
(If no, go to Section 12S)
SEAL CASES, DO
2.
I ask the Court to EXPUNGE AND IMPOUND the following arrests or charges from the
NOT FILL OUT
SECTIONS 2 - 11.
records of the Arresting Agency, the Circuit Clerk, and the Illinois State Police. I was arrested,
GO TO SECTION 12.
or charged without being arrested, and not convicted on the dates and for the offenses listed below:
See How to Expunge
Outcome
and/or Seal a Criminal
(for
Arrest or
Arresting
Date of
Record to make sure all
Charge
example,
Case Number
of your cases can be
Agency
Arrest
(list all charges for each case number)
RV, S or P)
erased by expunging
your record. For help
filling out this table, see
pages 12 – 15. Do not
list any convictions in
this section.
In 2, enter all eligible
arrests or charges on
your record. Enter all
charges for each case
number.
For Outcome, enter an
outcome that matches
the outcome of your
case. Use the
shortened version of
Outcome Abbreviations
the outcome from the
RV
P
Conviction Reversed or Vacated
Pardon from the Governor
Outcome
CE
FI
Certificate of Eligibility for Expungement from PRB
Found Factually Innocent
Abbreviations box.
If you need more room,
RWC
DA
Released Without Charge
Dismissal or Acquittal
use the Additional
S
Supervision Successfully Completed
QP
Qualified Probation Successfully Completed
Arrests or Cases for
I have listed additional arrests or cases on the attached Additional Arrests or Cases for
Expungement form and
check the box.
Expungement form.
EX-R 2903.4
(06/18)
Page 1 of 4
This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
REQUEST TO EXPUNGE &
CIRCUIT COURT
IMPOUND AND/OR SEAL
COUNTY
CRIMINAL RECORDS
Instructions
Directly above, enter
Request of:
the name of county
where you will file the
case.
Your name
(First, middle, last name)
Enter your name, birth
date, race, and gender.
List any other names
you used when
Other names used in these cases
arrested on the cases
listed on this form.
Date of birth
Race
Gender
Case Number
(if the Clerk
If the Clerk gave you a
assigns a new number)
new case number,
enter it to the right.
Arrest or Case Numbers of all Eligible Criminal Offenses on your Record in this County:
Enter the number for
all eligible arrests and
charges on your
criminal record in this
county. If an arrest did
not result in formal
charges, enter the
arrest number.
IF YOU ARE ONLY
1.
I am requesting to expunge and impound records.
REQUESTING TO
Yes
No
(If no, go to Section 12S)
SEAL CASES, DO
2.
I ask the Court to EXPUNGE AND IMPOUND the following arrests or charges from the
NOT FILL OUT
SECTIONS 2 - 11.
records of the Arresting Agency, the Circuit Clerk, and the Illinois State Police. I was arrested,
GO TO SECTION 12.
or charged without being arrested, and not convicted on the dates and for the offenses listed below:
See How to Expunge
Outcome
and/or Seal a Criminal
(for
Arrest or
Arresting
Date of
Record to make sure all
Charge
example,
Case Number
of your cases can be
Agency
Arrest
(list all charges for each case number)
RV, S or P)
erased by expunging
your record. For help
filling out this table, see
pages 12 – 15. Do not
list any convictions in
this section.
In 2, enter all eligible
arrests or charges on
your record. Enter all
charges for each case
number.
For Outcome, enter an
outcome that matches
the outcome of your
case. Use the
shortened version of
Outcome Abbreviations
the outcome from the
RV
P
Conviction Reversed or Vacated
Pardon from the Governor
Outcome
CE
FI
Certificate of Eligibility for Expungement from PRB
Found Factually Innocent
Abbreviations box.
If you need more room,
RWC
DA
Released Without Charge
Dismissal or Acquittal
use the Additional
S
Supervision Successfully Completed
QP
Qualified Probation Successfully Completed
Arrests or Cases for
I have listed additional arrests or cases on the attached Additional Arrests or Cases for
Expungement form and
check the box.
Expungement form.
EX-R 2903.4
(06/18)
Page 1 of 4
Enter the Case Number given by the Circuit Clerk: _________________________________
In 3-11, check ALL
3.
I was not convicted of any offenses I want to expunge, unless
:
(Check the box that applies)
boxes that apply.
a.
I was convicted, but the conviction was reversed or vacated; OR
In 3, you cannot
I received a pardon from the Governor of the State of Illinois allowing
b.
expunge a criminal
expungement.
; OR
(Attach a copy of the pardon.)
conviction unless one
of the special situations
c.
I received a Certificate of Eligibility for Expungement by the Prisoner Review
listed under checkboxes
Board.
; OR
(Attach a copy of the Certificate.)
a, b, c, or d describes
d.
I was found factually innocent in the case I am asking to expunge.
your case.
4.
For at least one case, I was arrested and released, and no charges were filed against me.
5.
For at least one case, I was arrested for a minor traffic offense and released from
custody without being charged.
6.
For at least one case, I was charged, but was later acquitted, or released without
In 7, your record must
being convicted.
specifically state that
7.
For at least one case, I received a sentence of Qualified Probation; AND
you had Qualified
a.
At least 5 years have passed since my Qualified Probation ended successfully;
Probation. It might also
be called Second
AND
Chance, 410, 710,
b.
I have attached the results of a drug test that I passed within the last 30 days.
1410, or TASC
8.
For at least one case, I received a sentence of supervision; AND
probation.
In 8, if you got
a.
For certain offenses listed in the law, at least 5 years have passed since
supervision for any case,
I completed my supervision successfully; OR
5 years must have
passed since the end of
b.
At least 2 years have passed since I completed my supervision successfully.
the sentence for:
9.
I am NOT seeking to expunge any arrests or charges that resulted in supervision for:
• Domestic Battery;
• Criminal Sexual
a.
Driving Under the Influence; OR
Abuse;
b.
Any sexual offense against a person under the age of 18; OR
• Driving without
c.
Reckless Driving when I was 25 years of age or older.
Insurance;
10. 
• Driving with
For at least one case, I received a sentence of supervision for Reckless Driving; AND
registration suspended
a.
I was under the age of 25 when the offense was committed; AND
for Non-Insurance;
b.
I have no other convictions for DUI or Reckless Driving; AND
• Display of False
c.
I have reached the age of 25.
Insurance Card;
• Scrap Processors to
11. 
I qualify to have my filing fees and State Police fees waived under the Cook County
Keep Records; OR
Fee Waiver Pilot Program:
• 2 years must pass
I am filing this Request in Cook County prior to January 1, 2019; AND
a.
since the end of the
sentence for all other
I am only seeking to expunge or seal arrests that resulted in my release without being
b.
supervisions (except
charged or in cases that resulted in my acquittal, dismissal of the case, or a reversed
those listed in 9, which
or vacated conviction.
can never be
expunged).
12. I am requesting to seal records.
IF YOU ARE ONLY
REQUESTING TO
Yes
No
(If no, skip Sections 13- 22)
EXPUNGE CASES,
DO NOT FILL OUT
SECTIONS 13 - 22.
See How to Expunge
and/or Seal a Criminal
Record to make sure
your cases can be
hidden by sealing your
record. For help filling
out this table see pages
12 – 15.
EX-R 2903.4
(06/18)
Page 2 of 4
Enter the Case Number given by the Circuit Clerk: _________________________________
In 13, enter all eligible
13.
I ask the Court to SEAL the following arrests, charges, or convictions from the records of the
arrests, charges, and
Arresting Agency, the Circuit Clerk, and the Illinois State Police:
convictions you want
sealed. Enter all
Arrest or Case
Charge
Outcome
(for
charges for each case
Number
Arresting
Date of
(list all charges for each case
example, MC,
number. For Outcome,
Agency
Arrest
number)
FC, or CE)
enter an outcome that
reflects the outcome of
your case. Use the
shortened version of
the outcome from the
Outcome
Abbreviations box.
If you need more room
to list additional
eligible arrests or
charges use the
Additional Arrests or
Cases for Sealing form
and check the box.
14– 16 must be true for
you to use this form.
Outcome Abbreviations
For 14, traffic offenses
MC
FC
Misdemeanor Conviction
Felony Conviction
cannot be sealed unless
CE
QP
Certificate of Eligibility for Sealing from PRB
Qualified Probation Successfully Completed
they were an eligible
I have listed additional arrests or cases on the attached Additional Arrests or Cases for
Class A or B
misdemeanor.
Sealing form.
In 17 - 21, check ALL
boxes that apply.
14.
I am not asking to seal arrests or charges for minor traffic offenses, unless I was released
In 17 and 18a –c, some
without being charged.
misdemeanor
15.
I am not asking to seal arrests or charges for felony offenses, unless the felony was reduced
supervisions and
convictions cannot be
to an eligible misdemeanor, or is otherwise eligible to be sealed.
sealed, like DUI, some
16.
I am not asking to seal a felony conviction that happened after the sealing of a prior felony
Reckless Driving
conviction.
Offenses, Domestic
Battery, some Sexual
 At least 2 years have passed since I successfully completed my supervision, for eligible
17.
Offenses, and Dog
offenses.
Fighting.
In 18b, some Class 3
18.
At least 3 years have passed since the end of my last sentence
; AND
(Unless #20 applies)
and Class 4 felony
(Check all that apply):
offenses can be sealed,
a. 
I received a misdemeanor conviction for an offense subject to sealing;
like Theft, Possession
of Cannabis,
b. 
I received a felony conviction for an offense subject to sealing. If it was a drug case,
Possession of a
I have attached the results of a drug test that I passed within the last 30 days.
Controlled Substance,
c. 
I successfully completed a sentence under Section 10 of the Cannabis Control Act,
and a few others.
For a complete list of
Section 410 of the Illinois Controlled Substances Act, Section 70 of the
crimes that can and
Methamphetamine Control and Community Protection Act, or Section 5-6-3.3
cannot be sealed, see
(Second Chance Probation) of the Unified Code of Corrections; AND I have
the How to Expunge
and/or Seal a Criminal
attached the results of a drug test that I passed within the last 30 days.
Record.
 I am not asking to seal a felony conviction for which I currently have to register on a
19.
In 21, check the box if
public registry, including the Arsonist Registration Act, the Sex Offender Registration Act,
you have completed one
or the Murder and Violent Offender Against Youth Registration Act.
of the listed educational
 For at least one case, I received a Certificate of Eligibility for Sealing by the Prisoner
20.
goals during your last
sentence. If 21 applies to
Review Board.
(Attach a copy of the Certificate.)
you, all eligible cases
 I am eligible to seal all eligible cases upon completion of my LAST sentence because
21.
can be sealed
immediately after the
I received a high school diploma, associate's degree, career certificate, vocational or
completion of your last
technical certification, or bachelor's degree, or passed the high school GED Test; AND
sentence.
a. I did so during the period of my LAST sentence, aftercare release, or mandatory
EX-R 2903.4
(06/18)
Page 3 of 4
Enter the Case Number given by the Circuit Clerk: _________________________________
supervised release; AND
b. I did not complete the same educational goal before.
c. I have attached to this Request proof of the program I completed.
 I am eligible to seal all eligible cases upon completion of my LAST sentence because
22.
I am a trafficking victim as defined under Section 10-9 of the Criminal Code of 2012, and as
such:
a.
I was a victim of human trafficking when my last offense was committed; AND
b.
My participation in the offense was a direct result of human trafficking under Section
10-9 of the Criminal Code of 2012 OR a severe form of trafficking under the federal
Trafficking Victims Protection Act.
 For at least one case, I received a conviction for Reckless Driving; AND
23.
Under the Code of
Civil Procedure,
735
a. I was under the age of 25 when the offense was committed; AND
ILCS
5/1-109, making
b. I have no other convictions for DUI or reckless driving; AND
a statement on this
form that you know to
c. I have reached the age of 25.
be false is perjury, a
Class 3 Felony.
I certify that everything in the Request To Expunge & Impound and/or Seal Criminal
If you are completing
Records is true and correct. I understand making a false statement on this form is perjury
this form on a
and has penalties provided by law under
735 ILCS
5/1-109.
computer, sign your
name by typing it. If
you are completing it
/s/
by hand, sign and
Your Signature
Date
print your name.
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You should use an email account that you do not share with anyone else and that you check every day. If you do not check your email every day, you may
miss important information or notice of court dates. Other parties may still send you court documents by mail.
I agree to receive court documents at this email address during my entire case.
Email
Enter your name,
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Prepared by:
address, and phone, or
that of your attorney, if
Street Address:
State’s Attorney/Prosecutor/ISP/Arresting
you have one.
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EX-R 2903.4
Page 4 of 4
(06/18)

Download Form EX-R 2903.4 Request to Expunge & Impound and/Or Seal Criminal Records - Illinois

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