1

IN THE OREGON CIRCUIT COURT

_________________ COUNTY

IN RE:

_______________________,

Petitioner.

6
7
8
9
10
11
12
13
14
15
16
17

)
)
)
)
)
)
)
)
)
)

Case No. ______________

MOTION TO SET ASIDE AND SEAL
RECORDS OF ARREST

COMES NOW the petitioner and respectfully moves the court for an order to set aside and seal
all record of arrest in the above matter pursuant to ORS 137.225. This motion is well founded in
law and is made in good faith.
Full Name: __________________Date of birth: ___________Sex: ______ Race: ___________
Mailing address:
Arresting agency: ___________ Arrest charge(s): ______________________________
Arrest date: ___________________
___________________________________________
Name
Certificate of service
I have served a copy of this Declaration in Support of Motion to Set Aside and Seal

18

Arrest Record on the _____________County District Attorney via US Mail on

19

(date)_____________ , along with a copy of the movants fingerprints.

20
21
22
23
Page 1 -

___________________________________________
Name:
Address:
Phone: