General Information

  1. Are you the legal guardian of a child under the age of 18 years old?

  2. Are you receiving any assistance from a Department of Workforce program, such as Medicaid, CHIP, Food Stamps, Refugee Cash Assistance, Family Employment Program, Temporary Assistance for Needy Families, or the WIC program?

Initial Expungement Questionnaire

  1. Do you have any criminal charges pending in court?

  2. Do you owe any fines or restitution to the courts or victims as of today’s date?

  3. Have you ever been convicted of a felony other than felony drug possession in the last seven years?

  4. Have you ever been convicted of a class A misdemeanor or felony drug possession in the last five years?

  5. Have you been convicted of a Class B misdemeanor in the last four years?

  6. Have you been convicted of a Class C misdemeanor in the last three years?

  7. Have you ever been convicted of a 1st degree felony or capitol offense?

  8. Have you ever been convicted of a felony automobile homicide?

  9. Are you or have you ever been a registered sex offender?

  10. Have you ever been convicted of a felony DUI?

  11. Have you ever been convicted of a misdemeanor DUI in the last 10 years?

  12. Have you ever been convicted of a violent felony?