Expungement Intake Form

Expungement Intake Form

Please fill out to the best of your ability. You must click "Submit" at the bottom of this page to complete the form.
Name*

First NameMiddle NameLast Name
Name You Were Charged Under*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number
Email*
example@example.com
Iowa county(s) where charges were filed
Date(s) of charge(s)
Case number(s)
Was/Were the charge(s) dismissed?

YesNoUnsure
Are any fines or court costs been paid off?

YesNoUnsure
Have you previously received a Deferred Judgment?

YesNoUnsure
Any other relevant information
By submitting this form I am authorizing the Des Moines Abolition Coalition and Des Moines Mutual Aid to research my public criminal record to determine if I am eligible to have charges expunged from public records and I am authorizing the Des Moines Abolition Coalition and Des Moines Mutual Aid to contact me for all further questions and follow ups only for the purpose of the completing and filing the Application for Expungement. I understand that there are no guaranteed results from filing this application.

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Waiver of Liability for Submitting Online Information
Effective Date: November 1st, 2024

By submitting information through the online forms provided on the iowamutualaid.org/expungement webpage, you (the "User") agree to the terms and conditions of this Waiver of Liability.

1. Acceptance of Terms

By clicking "Submit" or similar buttons, or by submitting information through any forms on the Website, you acknowledge that you have read, understood, and agree to be bound by the terms of this Waiver of Liability.

2. Voluntary Submission

You acknowledge that you are voluntarily submitting information to the Website and that you are solely responsible for the accuracy, completeness, and truthfulness of any information you provide.

3. No Guarantee of Confidentiality

While iowamutualaid.org, the Prison Abolition Coalition DSM, and Des Moines Mutual Aid takes reasonable measures to protect the information submitted through the Website, we can not guarantee absolute confidentiality or security. You understand that any information transmitted over the internet may be subject to interception, loss, or alteration.

4. Contact Information

If you have any questions about this Waiver of Liability or anything else about the Expungement Program, please contact us at:

Des Moines Abolition Coalition

c/o Des Moines Mutual Aid

4211 Grand Ave #3

Des Moines, IA 50312

desmoinesmutualaid@protonmail.com

By clicking "Submit" or using the forms on this Website, you acknowledge that you have read, understood, and agree to be bound by this Waiver of Liability.
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