Application for Pardon After Probation, Parole or Discharge (CFJ-515A)

Under 1, enter your Name, Telephone #, Address, Marital Status (Married, Divorced, Single or Widowed) and Number of Dependents.

Under 2, enter your Date of Birth, Place of Birth, U.S. Citizen (Yes or No), SS#, Sex, Race and Michigan Prison #.

Information under question # 2 is used for identification and statistical purposes only.

There are no limits to the number of misdemeanor offenses that may be expunged. Past felony criminal convictions are generally eligible for expungement seven years after the end of your sentence, term of probation or parole discharge while serious misdemeanors or individual felony convictions can be eligible for expungement after five years. An Application to Set Aside Conviction(s) is filed with the court or courts in the county of conviction, not with the Michigan Parole Board.

Have you reviewed the information and eligibility criteria for expungement/setting aside of the conviction? Mark Yes or No. If your answer to question #3 was Yes but you have not sought expungement, follow the directions in #5. If you have sought expungement and were denied, give the reasons for the denial.

If your answer to question #3 was Yes and you meet eligibility requirements, but you have not yet sought expungement, file an Application to Set Aside Conviction(s) in the Court where your conviction occurred. The Parole Board may not process this Application for Pardon After Parole or Discharge where expungement is available to the petitioner as an appropriate remedy, or the application may be denied based on the alternative remedy that is available.

State in full every other name by which you have been known, including the name under which you were convicted, the reason for your use of another name, and the dates during which you were so known (i.e. include your maiden name, name by a former marriage, aliases, and nicknames).

List the title of the crime(s) for each Michigan conviction for which you are requesting a pardon, stating whether it was a felony (F) or misdemeanor (M) (example: Home Invasion (F); Retail Fraud (M)), and provide the additional information.

The convictions listed must match the information on the required State of Michigan criminal records documentation (ICHAT).

Enter the Crime Title (felony (F) or misdemeanor (M)), the Sentence (length of jail/prison term, fine, probation, etc.) & Date of Sentence, the Court Name & Location (District Ct. & City or Circuit Ct. & County) (examples: 36th Dist. Ct. - Detroit; 13th Circuit Ct. - Leelanau County), the Judge (name) & Docket Number and the Discharge Date.

Have you attached the required ICHAT that can be obtained electronically from the Michigan State Police website (https://apps.michigan.gov/Home/Login)? Mark Yes or No. If you selected No, the application will not be processed.

8. Provide a complete and detailed account of each conviction listed under #7, for which you seek a pardon. Number each description in the same order as the crime is listed under #7. Describe all relevant factual circumstances. Attach additional pages if necessary to provide a full account.

Do you have any additional criminal convictions (juvenile or adult) other than those listed under #7? Mark Yes or No. If the answer to #9 is Yes, list the title of the crime for each conviction, stating whether it was a felony (F) or misdemeanor (M) (example: Home Invasion (F); Retail Fraud (M)), and provide the following information.

Enter the Crime Title, the Sentence & Date of Sentence, the Court Name & Location (District Ct. & City or Circuit Ct. & County, Federal District) (examples: 36th Dist. Ct.- Detroit; 13th Circuit Ct.- Leelanau County; U.S.Dist.Ct.Western Dist.MI.)(Include State if other than Michigan), the Judge (name) & Docket Number and the Discharge Date.

Do you have any pending criminal charges in any jurisdiction? Mark Yes or No. If the answer to # 11 is Yes, list the charges, location of the charges and explain the circumstances.

For all schools you have attended, starting with high school, enter the School Name, Location, Dates Attended and Degrees/Diplomas Awarded.

List all periods of employment and unemployment since the conviction or release from incarceration on the most recent crime you are seeking a pardon for, beginning with the present and working backward. All time periods must be accounted for.

For any periods of unemployment, list your means of support.

Enter the Employer, Address & Phone #, Type of Work/Position, Start/End Date and Reason for Leaving.

Have you ever served in the Armed Forces of the United States? Mark Yes or No.

If the answer to #15 is Yes, please provide the following information and a copy of your DD214: Dates of Service, Branch(es), Serial Number, Type of Discharge & Date and Decorations (if any).

If you were other than honorably discharged, describe in detail the factual circumstances surrounding your discharge.

Have you ever been denied any type of business or professional license, had any such license revoked, or had reinstatement of any such license denied? Mark Yes or No.

If the answer to #18 is Yes, state the nature of the license and the circumstances surrounding action taken.

Describe any charitable or civic activities in which you have been engaged, awards you have been presented or contributions you have made to the community, since the most recent conviction for which you are seeking a pardon. You may include the names of any organization(s), the time periods of your participation, your role and the name, phone number and address of any person from each organization who is familiar with your involvement.

State your reasons for seeking a pardon. Include specific information on how your life has been negatively impacted by the convictions for which you are seeking a pardon. Attach any documentation you have supporting your claim. (Examples include but are not limited to employment, denial of entry in the military, education, impact on family life, housing, volunteerism, etc.). If you are seeking a pardon in order to avoid deportation, please attach all relevant documentation supporting your immigration status, including any order(s) or documents issued by the U.S. Citizenship and Immigration Services and/or Homeland Security.

Sign on the Signature of Petitioner line and enter the Date. For the Notary, in accordance with 2003 PA 238, MCL 55.261 et seq.: on this day the petitioner personally appeared before the Notary, is known to the Notary to be the person who signed the petition either from personal knowledge or from satisfactory evidence.

Both copies of the application must have the signature of the petitioner (or if incapacitated, the person applying for the petitioner) and the Notary's stamp and signature.

Mail the application and supporting documentation to: Michigan Department of Corrections Office of the Parole Board Pardon and Commutation Coordinator Post Office Box 30003 Lansing, Michigan 48909.