EXPUNCTION CLINIC PRE-REGISTRATION FORM

FREE EXPUNCTION CLINIC

PRE-REGISTRATION FORM
THE LAW FIRM OF VAN CAMP, MEACHAM & NEWMAN, PLLC IS PROUD TO SPONSOR A PRO BONO (FREE) EXPUNCTION CLINIC

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- What is expunction? It is the removal of charges from a criminal record.
- We can assist with dismissed charges only but can refer you to counsel for convictions.
- Now serving 73 of 100 North Carolina Counties thanks to the Court’s e-filing system!
- Even if your case was dismissed, it might still show up on your record. We can help clear it.
- Not sure if you're eligible for an expunction? Register below and we'll review your case.
PLEASE REGISTER BELOW

and we will review your record to see if you are eligible for an expunction...
Contact Information
CONTACT NAME*

First NameMiddle NameLast NameSuffix
EMAIL*
example@example.com
PHONE NUMBER*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Verifying Information
SOCIAL SECURITY NUMBER*
Entire 9 digit number
DATE OF BIRTH*

MonthDayYear
MM-DD-YYYY
DRIVERS LICENSE NO.*
STATE DRIVERS LICENSE ISSUED*
(i.e., NC)
RACE*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinxNative Hawaiian or Other Pacific IslanderWhiteOther
SEX*

MaleFemale
Offense Information (not required, but helpful)
OFFENSE DESCRIPTION
i.e. DWI
AGE AT TIME OF OFFENSE
i.e. 18 years old
DATE OF OFFENSE/ARREST

MonthDayYear
MM-DD-YYYY
ARRESTING AGENCY
(i.e. Moore County Sheriff Department, Aberdeen Police Department, etc.)
OTHER AGENCY
(i.e. Moore County Sheriff Department, Aberdeen Police Department, etc.)
MOORE COUNTY COURT FILE #
(i.e. 19 CR 0123)
DATE OF DISMISSAL

MonthDayYear
MM-DD-YYYY
BY SUBMITTING THIS FORM, YOU AUTHORIZE THE LAW FIRM OF VAN CAMP, MEACHAM & NEWMAN, PLLC TO OBTAIN A COPY OF YOUR CRIMINAL RECORD FOR THE PURPOSES OF DETERMINING YOUR ELIGIBILITY FOR AN EXPUNGMENT.
If you have any questions or need to speak with someone, please email: Moore.Expunction@gmail.com.
Should be Empty:

FREE EXPUNCTION CLINIC

PLEASE REGISTER BELOW

If you have any questions or need to speak with someone, please email: Moore.Expunction@gmail.com.