CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR
Located at Case No.
Court Address
City/County
STATE OF MARYLAND
vs.
Defendant
Address
City, State, Zip
Telephone No. - Home
Telephone No. - Work
GENERAL WAIVER AND RELEASE
CC-DC/CR 78 (Rev. 10/2006)
TESTE:
Witness
Signature
(Seal)
* References to "Code" in this Petition are to the Annotated Code of Maryland.
I, , hereby release and forever
discharge , and the ,
all of its officers, agents, and employees, and any and all other persons from any and all claims which I may
have for wrongful conduct by reason of my arrest, detention, or confinement on or about .
This General Waiver and Release is conditioned on the expungement of the record of my arrest,
detention, or confinement and compliance with Code*, Criminal Article, § 10-103(c) or § 10-105, as
applicable, and shall be void is these conditions are not met.
WITNESS my hand and seal this day of , .
Complainant
Law Enforcement Agency
Month
Year
Date