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2. Application to Have Criminal Record Sealed
4. First Name*
5. Middle Name
6. Last Name*
8. Date of Birth*
9. Prior Legal Names
11. Phone Number*
12. Email Address*
14. Mailing Address*
16. City*
17. State*
18. Zip Code*
20. Preferred Communication Method (may still receive communication in other formats)

    1. Email

    1. Mail

    1. Phone
22. Have you been charged with a Felony offense in Winona County?

    1. Yes

    1. No

    1. I don't know
24. Were you convicted of a Felony in Winona County?

    1. Yes

    1. No

    1. I don't know
26. Was your entire case dismissed by the Court or the Prosecutor?

    1. Yes

    1. No

    1. I don't know
28. Were you acquitted of all counts by the Court or a Jury at trial?

    1. Yes

    1. No

    1. I don't know
30. Were you charged with a Felony but convicted of a lesser offense such as a Misdemeanor or Gross Misdemeanor?

    1. Yes

    1. No

    1. I don't know
32. Did you receive a stay of adjudication, stay of imposition, stay of execution, continuance for dismissal, deferred prosecution, reduced charge, or did you complete a diversion program?

    1. Yes

    1. No

    1. I don't know
34. I was charged with the following offense(s):

    Check all that apply to you

    1. 5th Degree Drug Possession or Sale
    2. Theft
    3. Receiving Stolen Property
    4. Damage to Property
    5. Forgery
    6. Possession or Sale of Stolen or Counterfeit Check

    1. Mail Theft
    2. Dishonored Check
    3. Financial Transaction Card Fraud
    4. False Declaration on Assistance Application
    5. I don't see my offense listed
36. Additional Comments
38. Signature*

    Please type your full name to indicate that you are requesting your application to have your criminal record sealed be reviewed for eligibility.

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field