STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
COUNTY
MOTION FOR DESTRUCTION OF
BIOMETRIC DATA AND ARREST RECORD
CASE NO. and JUDGE
ORI
MI-
Court address Court telephone no.
Police Report No.
Approved, SCAO
Form MC 235, Rev. 1/21
MCL 28.243, MCL 780.621, MCL 780.623, MCR 3.936(D)
Page 1 of 2
Distribute form to:
Court
Prosecutor
Defendant
THE PEOPLE OF
The State of Michigan
v
Defendant’s/Juvenile’s name, address, and telephone no.
CTN/TCN SID
In the matter of
JIS Code: MFO
Count CRIME
CHARGE CODE(S)
MCL citation/PACC Code
USE NOTE: This form is for use when the arresting agency or the Michigan State Police has failed to destroy the biometric data and arrest record as
required by law or when the Michigan State Police has not destroyed the biometric data and arrest record because the defendant has had a prior conviction
as stated in MCL 28.243(14)(h). This form is not for use in conjunction with setting aside an adjudication pursuant to MCL 712A.18e or setting aside a
conviction pursuant to MCL 780.621.
1. I,
Name (type or print)
, state that on
Date
I was found not guilty of all offense(s) charged in this case, and the arresting agency and/or Michigan State Police has
not destroyed the biometric data and arrest record as required by law.
I was found not to be within the provisions of MCL 712A.2.
The charges in this case were dismissed by nolle prosequi before trial, and the arresting agency and/or Michigan
State Police has not destroyed the biometric data and arrest record as required by law.
2. This motion does not pertain to any sentence imposed under MCL 333.7411, MCL 600.1076(4), MCL 762.11-
MCL 762.15, MCL 769.4a, MCL 750.350a, MCL 750.430, or to one of the crimes listed in MCL 28.243(14).
3. I REQUEST that my biometric data and arrest record be destroyed by the arresting agency and/or Michigan State Police.
Date
Signature
A hearing will be held on this motion on
Date and time
.
at
Location
before Hon.
.
MOTION
NOTICE OF HEARING
Motion for Destruction of Biometric Data and Arrest Record (1/21)
Page 2 of 2
Case No.
I served a copy of this motion and notice of hearing on the parties or their attorneys by first-class mail addressed to their
last-known addresses as defined by MCR 2.107(C)(3). I declare under the penalties of perjury that this certificate of mailing
has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date
Signature
CERTIFICATE OF MAILING
