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IN THE OREGON CIRCUIT COURT

_________________ COUNTY

IN RE:

_______________________,

Petitioner.

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Case No. ______________

MOTION FOR ORDER TO SET ASIDE
CONVICTION

COMES NOW the Defendant and respectfully moves the Court for an Order setting aside the
CONVICTION in the following matter:
Full Name:
Arrest Charge(s):

Date of Birth:

Date of Arrest:
Conviction Charge(s):

Arresting Agency:
Sentencing Date:

sition:
This Motion is based upon ORS 137.225 the records and files contained herein and the attached
Declaration.
__________________________________________
Date:_______________
Defendants Signature

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Prepared by:
Name:
Address:
City: State: Zip:
Telephone: ( )