REQUEST TO RESTRICT RECORD

For arrests after July 1, 2013
Please complete and submit a separate form for each individual.
This form must be completed in its entirety before request may be submitted to the Prosecuting Attorney's Office.

I request the record information (Date of Arrest and associated charges) described above pertaining to me be restricted from the record(s) of the arresting agency pursuant to the provisions of O.C.G.A. ยง35-3-37.

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