Rights Restoration Form

Rights Restoration Information Form
Name

First NameLast Name
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Sex

MaleFemale
Race

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderOther
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Present Address
MDOC Number
Social Security Number
County of Conviction
Year of Conviction
Please select the crime(s) for which the offender was convicted

ArsonArmed RobberyBigamyBriberyEmbezzlementExtortionFelony Bad CheckFelony ShopliftingForgeryLarcenyMurderObtaining Money or Goods under False PretensesPerjuryRapeReceiving Stolen PropertyRobberyTheftTimber LarcenyUnlawful Taking of Motor VehicleStatutory RapeCarjackingLarceny under Lease or Rental AgreementVoter Fraud
Are you looking for your record to be expunged?

YesNoNot Sure (Need Followup)
Should be Empty:

Rights Restoration Information Form