Expungement Intake Form

Please complete all applicable fields. This form collects information about your expungement matter. All information is confidential. Fields marked with * are required.

Your Contact Information

Full Name *

Phone *

Client Information

Maiden Name

Date of Birth

Address

Social Security Number

Charges You Want Expunged — Charge #1

Charges *

KRS (Statute Number)

County

Date

Description of Incident

Was a plea entered?

Yes No

Plea Details

Charges You Want Expunged — Charge #2

Complete if you have a second charge to expunge.

Charges

KRS (Statute Number)

County

Date

Description of Incident

Was a plea entered?

Yes No

Plea Details

Criminal History

Any prior felony convictions?

Yes No

Prior Charges

County

Date

Charges Since Expunged Charge

Have you had any charges since the charge(s) you want expunged?

Yes No

Charges #1

County

Date

Charges #2

County

Date

Charges #3

County

Date

Charges #4

County

Date

Additional Notes

Notes

Submitting this form does not create an attorney-client relationship. All information provided is kept confidential.

Your Contact Information

Client Information

Charges You Want Expunged — Charge #1

Charges You Want Expunged — Charge #2

Criminal History

Charges Since Expunged Charge

Additional Notes

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