Early Expungement Application – Fairfield County Juvenile Division

Last name First name Middle initial Date of birth Age Social Security Number Phone Address City State ZIP code

Has the record already been sealed

Yes No

Case number requested to be expunged row 1 left Case number requested to be expunged row 1 right Case number requested to be expunged row 2 left Case number requested to be expunged row 2 right Reasons the record should be expunged earlier than the automatic expungement period Applicant signature Date