Form FD-1114 FBI Expungement Form

FBI EXPUNGEMENT FORM
This form is to be used for State Expungements, Sealings, Governor’s
Pardons, Deletions, and/or Removal of Dates of Arrest or individual charges.
Information must be typed or legibly printed. Include State Bureau Stamp(s) if
required. Provide SID/Agency Case Number (OCA)/ORI if the FBI record shows
multiple arrests for one date.
Required information is marked with an asterisk (*).
*SUBMITTING AGENCY:

*Indicate your EXPUNGEMENT TERMINOLOGY:
Expungement
UCN #

*NAME

*DOB

Seal
ENTIRE
RECORD

Delete
DOA

Remove
FULL

Gov Pardon

PARTIAL-list charges

SID/OCA/ORI

If you are requesting a modification AND a deletion/removal/expungement for the same UCN#, then use
a separate Records Modification Form (FD-1115).
OMB: 1110-0064 FD-1114 Rev. 08/31/2018