Preliminary Application for Sealing or Expungement

SEALING AND EXPUNGEMENT PROGRAM
PRELIMINARY APPLICATION FOR SEALING/EXPUNGEMENT ELIGIBILITY
NAME: ___________________________________________________________________________
First
Middle
Last
ALIASES or OTHER NAMES USED: ______________________________________________________
MAILING ADDRESS: _________________________________________________________________
Street Address
City
State
Zip Code
PERMANENT ADDRESS: ______________________________________________________________
Street Address
City
State
Zip Code
PHONE: __________________________________
E-MAIL: ___________________________________
RACE: ______________
SEX: ____________
DATE OF BIRTH: ___________________________
SOCIAL SECURITY NUMBER: __________________________________
(You do not need to provide your social security number if you do not want to. But, failure to do so may delay the processing time of your application).
FLORIDA DRIVER’S LICENSE OR ID NUMBER: __________________________________________  ID Verified
ARREST INFORMATION
In what County and State were you arrested?
When? (Approximate date and/or year)
___________________________________________
___________________________________________
___________________________________________
___________________________________________
(Attach additional page if needed).
(Attach additional page if needed).
QUESTIONS
HAVE YOU EVER APPLIED TO HAVE YOUR RECORD SEALED OR EXPUNGED?
 Yes  No
HAVE YOU BEEN CONVICTED (ADJUDICATED) OF A FELONY, MISDEMEANOR,
DRIVING WITH A SUSPENDED LICENSE, DUI, OR RECKLESS DRIVING?
 Yes  No
WERE YOU ARRESTED AS A JUVENILLE?
 Yes  No
ARE YOU CURRENTLY ON PROBATION OR HAVE A PENDING CASE?
 Yes  No
STATE ATTORNEY’S OFFICE USE ONLY – DO NOT WRITE BELOW THIS LINE
 Eligible
 Seal
 Expunge
 Not Eligible / Reason: __________________________________________
________________________________________________________________
Reviewed by: ____________________________________ Date: _________________________
 FDLE Application prepared and mailed
 Notice of ineligibility provided via mail
Revised 9/2015
DO YOU HAVE AN ARREST RECORD?
Arrest records can sometimes keep you from gainful employment, renting a place
to live, make you unable to obtain certification or special licenses, and can create
many other problems.
Having a chance to keep an arrest record from public view
is an opportunity not to be missed.
That is why the Office of the State Attorney is offering this Sealing and Expungement Program. If
you were charged with a crime in BROWARD COUNTY and the case did not result in a conviction, you
may be eligible to have a single arrest record sealed or expunged. Only cases that occurred in
Broward County in State Court will be reviewed.
The first step towards having a record Sealed or Expunged is to apply for a Certificate of
Eligibility from the Florida Department of Law Enforcement (FDLE). Come in to the State
Attorney’s Office at any of our locations and fill out a one page application. We will help answer your
questions about this process and at no cost to you, will determine if you qualify. If you qualify,
our staff will prepare the FDLE Application for Certification of Eligibility for you and gather the
documents that must be submitted with it. Please note that when you submit the completed
application to the Florida Department of Law Enforcement, they require a $75.00 processing fee.
Please review the back side of this flyer for the address of
THE STATE ATTORNEY’S main office as well as our three satellite locations.
For additional information, please contact Elizabeth Honorat at the
State Attorney’s Office at (954) 831-7209 or visit our website at www.sao17.state.fl.us.
Revised 9/2015
You may pick up and fill out the
Preliminary Application for Sealing/Expungement Eligibility
at any of our Courthouse locations or you may print a copy by
visiting our website at www.sao17.state.fl.us. Please bring the completed
application along with picture identification into any of our locations.
We will need to confirm the identity of the applicant
by checking valid Florida Issued Picture ID.
COURTHOUSE LOCATIONS
CENTRAL COURTHOUSE
Office of the State Attorney
201 SE 6th Street, Room 655
Fort Lauderdale, Florida 33301
(954) 831-6955
SOUTH SATELLITE COURTHOUSE
Office of the State Attorney
WEST SATELLITE COURTHOUSE
Office of the State Attorney
3550 Hollywood Blvd., Room 205
Hollywood, Florida 33021
(954) 831-0340
100 N Pine Island Road, Room 200
Plantation, Florida 33324
(954) 831-2350
NORTH SATELLITE COURTHOUSE
Office of the State Attorney
1600 W Hillsborough Blvd., Room 120
Deerfield Beach, Florida 33442
(954) 831-1250
Revised 9/2015