AND TRAFFIC CITATIONS
IN THE CIRCUIT COURT OF COUNTY, XXX
Petitioner (First/Middle/Last)
IN RE: Expungement of Record of:
Circuit Court Case No.
Magistrate Court Case No.
Address: DOB: / /
SSN: XXX-XX-
PETITION FOR EXPUNGEMENT OF MISDEMEANOR VIOLATIONS
AND TRAFFIC CITATIONS
W. Va .XXX
Phone No.
Conviction Date:
Comes now the petitioner, pro se, pursuant to §61-11-26 and/or §61-11-26a to expunge the following
misdemeanors in the above referenced case:
CHARGE:
CASE NO.:
CASE NO.:
CASE NO.:
CASE NO.:
CHARGE:
CHARGE:
CHARGE:
For the expungement under WV Code §61-11-26 of multiple above listed and described misdemeanor
convictions or traffic citation(s), where the petitioner satisfies the requirements of §61-11-26a(1) or
§61-11-26a(2), or both, if applicable, one year has passed since any conviction and completion of
petitioner’s sentence and any period of supervision. The date of eligibility is:
Petitioner must provide documentation required under §61-11-26a(b).
.
For the expungement under WV Code §61-11-26 of multiple above listed and described misdemeanor
convictions or traffic citation(s), two years have passed since any conviction and the completion of
petitioner’s sentence and any period of supervision. The date of eligibility is:
documentation required under §61-11-26a(b).
. Petitioner must provide
For the expungement under WV Code §61-11-26 of a single above listed and described misdemeanor
conviction or traffic citation(s), where the petitioner satisfies the requirements of §61-11-26a(1) or
§61-11-26a(2), or both, if applicable, following the completion of petitioner’s sentence and any period
of supervision. The date of eligibility is:
In Support of this Petition, the Petitioner states as follows:
a. The charge(s) noted above are not excluded under §61-11-26(c).
b. Petitioner has no pending charges at this time.
c. Petitioner has completed eligibility requirements for expungement as prescribed by one of the below:
.
For the expungement under WV Code §61-11-26 of a single above listed and described misdemeanor
conviction or traffic citations(s), one year has passed since the completion of petitioner’s sentence and
any period of supervision. The date of eligibility is: .
SCA-C906: Petition for Expungement of Misdemeanor Violations
Revised: 06/04/2019; WVSCA Approved: 06/04/2019 Page 2 of 4
d. Petitioner’s current name, previous names, and all aliases:
g. Petitioner was convicted on the following charges:
e. All of petitioner’s addresses from the date of offense to current:
f. Date of arrest:
.
.
.
.
h. Name(s) of victim(s) if applicable:
i. Is there a current order for restitution, protection, restraining order or other no contact order prohibiting the
petitioner from contacting victim(s)?
Yes (If yes, attach copy of order to this petition)
No
Was there a prior order for restitution, protection, restraining order or other no contact order prohibiting
the petitioner from contacting victim(s)?
Yes
No
.
j. The Court’s verdict and punishment imposed was:
.
(please explain in detail):
k. Grounds for expungement request, including but not limited to employment or licensure purposes
l. Steps petitioner has taken since the time of the offense towards personal rehabilitation, including
treatment, work, or other personal history that demonstrates rehabilitation (please explain in detail):
SCA-C906: Petition for Expungement of Misdemeanor Violations
Revised: 06/04/2019; WVSCA Approved: 06/04/2019 Page 3 of 4
Yes
No
m. Has petitioner ever been granted expungement or similar relief regarding a criminal conviction by any
court in this state, in any other state, or by any federal court?
n. Petitioner has attached any supporting documentation, sworn statements, affidavits, and/or other
information supporting the petition to expunge.
Wherefore, pursuant to WV Code §61-11-26, the petitioner respectfully requests that this Honorable Court expunge
the conviction(s), and the records associated therewith, as provided in this petition.
Signature of Petitioner
facts I have stated in this Petition are true to the best of my personal knowledge and belief; and if I have provided
information given to me by others, I believe that information to be true.
after making an oath or affirmation to tell the truth, say that the I,
Signature of Petitioner Date
This Verification was sworn to or affirmed before me on the day of , 20 .
Notary Public/Other Official
VERIFICATION
My commission expires: .
SCA-C906: Petition for Expungement of Misdemeanor Violations
Revised: 06/04/2019; WVSCA Approved: 06/04/2019 Page 4 of 4
CERTIFICATE OF SERVICE
The Superintendent of the State Police, at
The County Prosecuting Attorney’s Office, at
the offense(s) were committed, at
The Chief of Police (or other Executive Head of the Municipal Police Department where
The Superintendent or Warden of any institution in which Petitioner was confined (if applicable) at
The Municipal Court that disposed of the Petitioner’s criminal charges (if applicable) at
The Circuit Court that disposed of the Petitioner’s criminal charges (if applicable) at
The Magistrate Court that disposed of the Petitioner’s criminal charges (if applicable) at
By the following method:
First Class Mail
Hand Delivery
Certified Mail – Return Receipt
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