Cannabis Record Suspension Application Form

Cannabis Record Suspension Application Form
Full Name*

PrefixFirst NameMiddle NameLast Name
Other Names Used or Alias:
Name used when you were charged.
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Other Phone:

Area CodePhone Number
E-mail*
Is your Conviction for Simple Cannabis Possession Under 30 grams? (not including possession of Hash, Oil, or for the Purpose of Trafficking or for Possession of any other Narcotic)*

YesNo
If No, explain:
Do you have any other convictions on your Record?*

YesNo
If Yes, explain:
(If you have any other convictions, you will need a Record Suspension.)
Does the conviction for Possession of Narcotic still show on your RCMP Record?*

YesNo
I wish to pay $299 plus GST to Cannabis Record Suspensions.com for them to do everything, plus disbursement fees (Fingerprinting, Local Police Records Check, Court Records).*

YesNo
Please verify that you are human*
Should be Empty: