Application for Sealing or Expungement - Pickaway County Common Pleas Court

State of Ohio versus defendant name Case number Defendant name row 1 Case number row 1

Application request row 1

Row 1 seal conviction or bail forfeiture Row 1 expunge conviction or bail forfeiture Row 1 seal not guilty or dismissal Row 1 expunge not guilty or dismissal

Defendant name row 2 Case number row 2

Application request row 2

Row 2 seal conviction or bail forfeiture Row 2 expunge conviction or bail forfeiture Row 2 seal not guilty or dismissal Row 2 expunge not guilty or dismissal

Defendant name row 3 Case number row 3

Application request row 3

Row 3 seal conviction or bail forfeiture Row 3 expunge conviction or bail forfeiture Row 3 seal not guilty or dismissal Row 3 expunge not guilty or dismissal

Date Proof of service day Proof of service month Proof of service year Applicants full legal name Alias or maiden name Telephone number Date of birth Social Security number Sex Race Address City State Zip