CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR
Located at Case No.
City/County
Court Address
STATE OF MARYLAND
vs.
Defendant
DOB
FORM 4-504.1. PETITION FOR EXPUNGEMENT OF RECORDS
Date
Date
Signature of Defendant
Address
Telephone Number
CC-DC/CR 72 (Rev. 8/2006)
1. (Check one of the following boxes) On or about , I was arrested, served with a summons,
or served with a citation by an officer of the
at , Maryland, as a result of the following incident
Date
Law Enforcement Agency
2. I was charged with the offense(s) of
3. On or about , the charge was disposed of as follows (check one of the following boxes):
I was acquitted and either three years have passed since disposition or a General Waiver and Release is attached.
The charge was dismissed or quashed and either three years have passed since disposition or a General Waiver
and Release is attached.
A judgment of probation before judgment was entered on a charge that is not a violation of Code*, Transportation
Article, § 21-902 or Code*, Criminal Law Article, §§ 2-503, 2-504, 2-505, or 2-506, or former Code*, Article 27,
§ 388A or § 388B, and either (a) at least three years have passed since the disposition, or (b) I have been discharged
from probation, whichever is later. Since the date of disposition, I have not been convicted of any crime, other than
violations of vehicle or traffic laws, ordinances, or regulations not carrying a possible sentence of imprisonment; and
I am not now a defendant in any pending criminal action other than for violation of vehicle or traffic laws, ordinances,
or regulations not carrying a possible sentence of imprisonment.
A Nolle Prosequi was entered and either three years have passed since disposition or a General Waiver and
Release is attached. Since the dat