MLK Day Clinic

·The information You enter here in this form or relayed to Attorney(s) will be the basis of any attempted expungement petition filed for You. If You, as a matter of law or discretion, are ineligible for an expungement, an Attorney(s) will do their best to let you know prior to filing. The filing of an unsuccessful or withdrawn petition does not generally preclude future attempts at refiling.

·The Attorney(s) do not have access to your complete FBI Criminal Case History to prepare this petition. If You fail to inform the Attorney(s) of any charges not currently in the Court's computer system, in New Jersey or anywhere else (domestic or foreign), and/or don't have documentation regarding those charges, the Attorney(s) may not be able to file your expungement today and/or it may cause the expungement petition to be denied.

·You are, by submitting this form, giving the Attorney(s) the permission to attempt to retrieve and review as much of Your criminal history as possible to advise You.

·If any charges are not available to expunge through the Court's system - You may be informed by the Attorney(s) that they were possibly included in the New Jersey Court's automatic expungement.

·The Attorney(s) will utilize the NJ Court's Expungement Portal to electronically create Your expungement petition but will also let You know if there may be any potential detriments to filing.

·The Attorney(s) will require good contact information and cooperation from You, to keep you informed and involved in the petition's review process.

·No Attorney(s) makes any guarantee of success of Your petition for expungement.

·Attorney(s) may, at their discretion, choose not to file a petition for any applicant for any reason.

·If You have pending charges or have previously filed for an expungement, you may be ineligible.

·If You have an outstanding financial obligation to the Court, including fines, fees, or restitution, the petition may convert those amounts to judgments against you.

·If You commit a crime or offense after this expungement, the Court may "unexpunge" records expunged in this petition.

·For value received from Attorney(s), including looking up and reviewing the Party Court History, You hereby waive and hold harmless any and all sponsors, attorneys, and involved parties, paid or volunteer, related to or involved at the venue, in the review and potential expungement process provided at this clinic.

·Attorney(s) do NOT agree to represent you through an objection or appeal, if such is necessary, absent a separate signed agreement at the sole discretion of Attorney(s).

Name*

First NameMiddle NameLast NameSuffix

Include any maiden name or aliases: enter here

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Date of Birth*

Date

Please Check Any That Apply to You:

Previously Filed for ExpungementCharged or Convicted of an "Indictable" OffenseBeen on Parole, Probation or Court related Supervision in the past 5 yearsA Natural Born or Naturalized Citizen of the United StatesName Legally Changed, including by MarriageHave Outstanding Fines or Obligations to any CourtUndocumented Individual

Please Check if You Have Been Charged or Convicted of Any Offense Below:

To the best of your knowledge, what were you charged with and where did the offense(s) occur, and what were the outcome(s)? If you do not recall, the Attorney(s) will do their best to look up this information.

Please Answer

Do you need help with a State ID?

Lost IDExpired ID

Are you a Veteran?

YesNo

Signature*

Expungement Intake Agreement

Please Complete Prior to Meeting with Volunteer Attorney(s)

The limited scope of this Agreement is for Blaze Responsibly LLC and its Volunteer Attorney(s) to help the Applicant ("You") with the preparation and submission of a petition for expungement in the State of New Jersey.

Thank you for completing this Intake Form. By signing below and clicking "Submit" you agree to the terms listed above and permit the Attorney(s) to look up your court records in NJ in an attempt to prepare and submit an expungement petition on your behalf.