STATE OF SOUTH CAROLINA
IN THE MAGISTRATE/MUNICIPAL COURT
COUNTY/MUNICIPALITY OF
APPLICATION FOR EXPUNGEMENT
PURSUANT TO §17-22-950(B)
THE STATE OF SOUTH CAROLINA

Race

Sex

DOB

SSN

vs.
SID #

Charge was disposed of in the court indicated below:
Defendant
Magistrate Municipal
Current Address
AKA

The Defendant makes application to this court for the expungement of all records of the charge described below. Pursuant to §17-22-950(B), the charge was not dismissed at a preliminary hearing and I do not have charges pending in the summary court and a court of general sessions that arise out of the same course of events.

Full Name (at time of arrest): __________________________________________________________________________

Phone Number: ____________________________________________________________________________________

Date of Offense: ________________________	Warrant/Ticket Number: ______________________________________

Charge: ___________________________________________________________________________________________

Arresting Agency: ___________________________________________________________________________________

Were you fingerprinted for this charge?	____ Yes	____ No	____ Do Not Know

Disposition: _____________________________ Date of Disposition: _________________________________________

Attorney Name (if represented): _______________________________________________________________________

Attorney Address: ___________________________________________________________________________________

NOTE: If this charge was dismissed or nolle prossed because of successful completion of the Pre-Trial Intervention Program, Traffic Education Program, Alcohol Education Program, Conditional Discharge, or any other statutorily authorized diversion program operated by a solicitor's office, you must apply for an expungement at the solicitor's office.

_____________________________________________

Signature

SCCA 223E (5/16)

Lipson, Renee A.

2016-05-05

Rosengrant, Deb