­­I request the arrest record information described above pertaining to me be restricted from the record(s) of the arresting agency pursuant to the provisions of O.C.G.A. 35-3-37(d).

I hereby give my consent for the Office of the Fulton County Solicitor General and Georgia Justice Project to receive any Georgia criminal history record information pertaining to me, as authorized under state and federal law for individuals with a criminal justice agency.

I am requesting that the Office of the Fulton County Solicitor-General and Georgia Justice Project review my application for eligibility to restrict eligible convictions. In making this request, I understand the following:

I am limited to a lifetime maximum of two restrictions of convictions under the new law;
Depending on my criminal history, I may be eligible for retroactive First Offender treatment; and

In order to be eligible for restriction, I also understand that:

– My charges might qualify for restriction;
– Charges that do not qualify include sex crimes, theft crimes (except shoplifting and retail fraud), crimes involving family violence unless under the age of 21 at arrest, and serious traffic offenses.
– I have completed my sentence;
– It has been four years without any conviction in any jurisdiction (except minor traffic offenses); and
– I have no pending charges in any jurisdiction.