"AZ" FREE EXPUNGEMENT INTAKE FORM

AZ FREE EXPUNGEMENT INTAKE FORM

"SAY YES TO SECOND CHANCES"
Please enter the name in your arrest record or conviction if known.*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Arizona County of Residence*
Arizona County of your Cannabis Arrest/Conviction*
Do you have a cannabis arrest/conviction in more than one Arizona County?*
Do you have any other charges that aren't Cannabis related on your record?*
Do you have your Record (RAP SHEET) in hand?*
File Upload RAP SHEET

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AZ FREE EXPUNGEMENT INTAKE FORM