Form NHJB-3056-DSE "Petition of Eligibility for Annulment of Record Non-conviction: for Offenses Resolved 01/01/2019 or Later" - New Hampshire

What Is Form NHJB-3056-DSE?

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

Form Details:

  • Released on August 6, 2019;
  • The latest edition provided by the New Hampshire Judicial Branch;
  • 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 NHJB-3056-DSE by clicking the link below or browse more documents and templates provided by the New Hampshire Judicial Branch.

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Download Form NHJB-3056-DSE "Petition of Eligibility for Annulment of Record Non-conviction: for Offenses Resolved 01/01/2019 or Later" - New Hampshire

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name:
Case Name:
Case Number:
Charge ID:
(if known)
PETITION OF ELIGIBILITY FOR ANNULMENT OF RECORD NON-CONVICTION:
For offenses resolved 01/01/2019 or later
PLEASE COMPLETE A SEPARATE FORM FOR EACH OFFENSE
APPLICANT’S INFORMATION
Full Name:
Date of Birth:
Address:
City/Town
State
Zip Code
Telephone Number:
E-mail Address: (optional)
CHARGE INFORMATION AND APPLICANT’S CERTIFICATION
(Select all checkboxes that apply)
No charges were ever filed in court. The applicant seeks only annulment of any record of arrest.
RSA/Statute:
Charge:
Date of Arrest:
Law Enforcement Agency:
Charges were filed, but were dismissed, not prosecuted (nolle prossed), or the conviction was
vacated. The applicant seeks annulment of any record of arrest and the offense/charge.
Charge:
Charge Date:
Date of
Disposition Type:
Disposition:
For petitions with charges filed:
The applicant states this offense is eligible for annulment as it has been at least 30 days following
the entry of the non-conviction disposition if an appeal was not taken, or upon final determination of
the appeal affirming the disposition.
The applicant was found NOT GUILTY of all other charges stemming from the same arrest.
NHJB-3056-DSe (08/06/2019)
Page 1 of 2
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Clear Form
Lock & Save Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name:
Case Name:
Case Number:
Charge ID:
(if known)
PETITION OF ELIGIBILITY FOR ANNULMENT OF RECORD NON-CONVICTION:
For offenses resolved 01/01/2019 or later
PLEASE COMPLETE A SEPARATE FORM FOR EACH OFFENSE
APPLICANT’S INFORMATION
Full Name:
Date of Birth:
Address:
City/Town
State
Zip Code
Telephone Number:
E-mail Address: (optional)
CHARGE INFORMATION AND APPLICANT’S CERTIFICATION
(Select all checkboxes that apply)
No charges were ever filed in court. The applicant seeks only annulment of any record of arrest.
RSA/Statute:
Charge:
Date of Arrest:
Law Enforcement Agency:
Charges were filed, but were dismissed, not prosecuted (nolle prossed), or the conviction was
vacated. The applicant seeks annulment of any record of arrest and the offense/charge.
Charge:
Charge Date:
Date of
Disposition Type:
Disposition:
For petitions with charges filed:
The applicant states this offense is eligible for annulment as it has been at least 30 days following
the entry of the non-conviction disposition if an appeal was not taken, or upon final determination of
the appeal affirming the disposition.
The applicant was found NOT GUILTY of all other charges stemming from the same arrest.
NHJB-3056-DSe (08/06/2019)
Page 1 of 2
Top of Page
Case Name:
Case Number:
PETITION OF ELIGIBILITY FOR ANNULMENT OF RECORD (NON-CONVICTION)
I swear or affirm, under penalties of law, that the above facts are true and correct to the best of my
knowledge.
Date
Applicant’s Signature
Name of Counsel
Counsel’s Signature
Address
Address
FOR COURT USE ONLY:
IT IS ORDERED AND CERTIFIED:
CERTIFICATE OF ANNULMENT
That the record of arrest is hereby annulled. The applicant has shown that issuance of this order is
warranted under the statute.
That the record of the charge and disposition of dismissal, acquittal or nolle prosequi in the above
referenced matter, together with any record of arrest or charge therein, is hereby annulled. The
applicant has shown that issuance of this order is warranted under the statute.
The Court DENIES the applicant’s petition for the following reason(s):
Date
Signature of Judge
Printed Name of Judge
CC:
Prosecutor
Defendant
Defense Attorney
Dept. of Safety – Criminal Records
DMV
Dept. of Corrections
Police Department
Other
Attorney General
District Division #
Sentence Review
NHJB-3056-DSe (08/06/2019)
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