Form 40 021 PDF Details

Form 40 021 is a form that is used by the IRS to collect information about your foreign bank and financial accounts. This form is required to be filed if you have more than $10,000 in foreign bank and investment accounts at any time during the year. The deadline for filing this form is June 30th of the following year. Failing to file this form can result in significant penalties, so it's important to understand what's involved and make sure you submit it on time.

If you need to find out a handful of specific details with regards to the file you're going to work with, here is the data you might want to go through prior to filling in the form 40 021.

QuestionAnswer
Form NameForm 40 021
Form Length6 pages
Fillable?Yes
Fillable fields33
Avg. time to fill out8 min 6 sec
Other namesflorida fdle 40, fdle 40 form, florida 40 form, law enforcement 40 form

Form Preview Example

<![endif]>SECTION A – ALL APPLICANTS

<![endif]>SECTION B – STATE ATTORNEY

<![endif]>FOR EXPUNCTION APPLICATIONS ONLY

<![endif]>SECTION C

<![endif]>FDLE

FLORIDA DEPARTMENT OF LAW ENFORCEMENT

APPLICATION FOR CERTIFICATION OF ELIGIBILITY

PLEASE TYPE OR PRINT ALL INFORMATION

 

Last Name

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aliases: Maiden: Divorce

 

 

 

 

Residence Phone

 

Business Phone

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (DOB)

 

 

 

 

 

 

 

Race

 

 

 

Sex

 

Social Security No.

 

 

 

 

 

 

MONTH

DAY

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

 

 

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permanent Address

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

 

 

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Arresting Agency

 

Date(s) of Arrest

 

 

 

 

 

 

 

Florida Drivers License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select One: _____Expunge

_____Seal

 

NOTE: For Expunction applications, the State Attorney or Statewide Prosecutor must complete Section B.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Charge(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(PLEASE STAMP WITH SEAL)

 

1.

 

__________________________________________

 

 

 

 

 

 

Sworn to and subscribed before me

 

 

 

2.

 

__________________________________________

 

 

 

 

 

 

This ______ Day of _______________, 20____________

3.

 

__________________________________________

 

 

 

 

 

 

______________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

__________________________________________

 

 

 

 

 

 

 

(Signature of Notary Public)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________

 

I hereby certify that the information contained herein is

 

 

 

 

 

 

(Print, Type, or Stamp Commissioned Name of Notary

 

true and correct to the best of my knowledge.

 

 

 

 

 

 

 

 

 

or Deputy Clerk of the Court)

 

 

 

 

 

 

 

___________________________________________

 

 

 

 

 

 

Personally Known ____ or Produced Identification _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

Type of Identification Produced: ____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State Attorney/Statewide Prosecutor

 

 

County

 

 

 

 

 

 

 

Circuit

 

 

 

Reviewing Officer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Charge(s) Description

 

 

 

Statute Violation

 

Case Number

 

 

 

Action

1. ___________________________________

 

EXPUNCTION___________________ _________________

 

_________________

2. ___________________________________

 

 

_________________

3.

___________________________________

FOR

 

_________________

 

 

 

 

 

APPLICATIONS ONLY

 

4. ___________________________________

 

 

 

 

 

 

 

 

 

_________________

 

 

 

_________________

 

If one of the paragraphs below is checked, my signature below indicates that, based on the

 

 

The above-referenced case is not eligible to be expunged because:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

disposition of all charges related to the above-referenced case, that case is eligible to be

 

 

One or more of the charges (acts) related to the arrest or alleged criminal activity to which the

 

expunged, if the applicant is otherwise eligible to have his or her record expunged under law. My

 

 

 

signature does not imply that the applicant has satisfied all other statutory eligibility criteria, or

 

 

 

 

 

application for certificate of eligibility to expunge pertains resulted in an adjudication of guilt or

 

that this Office would not oppose a petition to expunge the above-referenced case. By checking

 

 

 

 

 

of delinquency;

 

 

 

 

 

 

 

 

 

paragraph 1, 2, or 3, I certify that the above-referenced case is presently eligible to be expunged,

 

 

OR, BECAUSE OF ONE OR MORE OF THE FOLLOWING REASONS:

 

 

 

 

assuming that the applicant is otherwise eligible, because:

 

 

 

 

 

 

 

 

 

 

 

1. An indictment, information, or other charging document was not filed or issued in the

 

 

The record of the arrest or alleged criminal activity to which the application for certificate of

 

 

 

case; OR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

eligibility to expunge pertains has not been sealed for at least 10 years;

 

 

2. An indictment, information, or other charging document, if filed or issued in the case,

 

 

One or more of the charges for which an adjudication of guilt or of delinquency was withheld

 

 

 

was dismissed or nolle prosequi by the state attorney or statewide prosecutor, or was

 

 

 

 

 

relate to a to a violation of s. 393.135, s. 394.4593, s. 787.025, chapter 794, s. 796.03, s.

 

 

 

dismissed by a court of competent jurisdiction; OR

 

 

 

 

 

 

 

 

 

 

800.04, s. 810.14 s. 817.034, s. 825.1025, s. 827-071, chapter 839, s. 847.0133, s. 847.0135,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

s. 847.0145, s. 893.135, s. 916.1075, a violation enumerated in s. 907.041, or any violation

 

3. (a) None of the charges (acts) related to the arrest or alleged criminal activity to which

 

 

 

 

 

specified as a predicate offense for registration as a sexual predator pursuant to s. 775.21,

 

 

 

the application for certificate of eligibility to expunge pertains resulted in an adjudication of

 

 

 

 

 

without regard to whether that offense alone is sufficient to require such registration, or for

 

 

 

guilt or of delinquency; AND

 

 

 

 

 

 

 

 

 

 

 

registration as a sexual offender pursuant to s. 943.0435;

 

 

 

 

 

 

(b) The record of the arrest or alleged criminal activity to which the application for

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

certificate

of eligibility to expunge pertains has been sealed for at least 10 years; AND

 

 

Records available to this Office disclose some other ground of statutory ineligibility (e.g.,

 

 

 

(c) None of the charges (if any) for which adjudication of guilt or of delinquency was

 

 

 

 

 

withheld relates to a violation of s. 393.135, s. 394.4593, s. 787.025, chapter 794, s.

 

 

 

 

 

adjudication of guilt in a different case; previous expunction or sealing).

 

 

 

 

796.03, s. 800.04, s. 810.14, s. 817.034, s. 825.1025, s. 827.071 chapter 839, s.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

847.0133, s. 847.0135. s. 847.0145, s. 893.135, s. 916.1075, a violation enumerated in s.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

907.041, or any violation specified as a predicate offense for registration as a sexual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

predator pursuant to s. 775.21, without regard to whether that offense alone is sufficient

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to require such registration, or for registration as a sexual offender pursuant to s.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

943.0435.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________

 

 

____________________________________________________

 

Signature

Title(Prosecuting Authority)

 

Date

 

 

 

 

Signature

Title(Prosecuting Authority)

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct/Budget

 

 

 

Expunge/Seal Section

 

 

 

 

 

Expunge/Seal Section

 

Date Received __________________

 

I.D.# ________________ORI _______________

Date Received __________________

 

Check _________________________

 

Certification Status

Approved

 

Denied

Date Entered ___________________

 

Processed By ___________-_______

 

Seal

 

 

 

 

 

 

 

 

 

 

 

 

Date Mailed ____________________

 

 

 

 

 

 

 

 

Expunge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: A CERTIFICATE OF ELIGIBILITY IS VALID FOR 12 MONTHS FROM THE DATE OF ISSUANCE. AFTER THAT TIME, A NEW CERTIFICATE MUST BE APPLIED FOR.

Revised December 2009

Ref. Rules 11C-7.006 and 11C-7.007

FDLE 40-021

GENERAL INSTRUCTIONS & INFORMATION:

1.Applicable law: Sections 943.0585 and 943.059, Florida Statutes, and Chapter 11C-7, Florida Administrative Code (FAC), govern the use of this application, for the expunction or sealing of non-judicial criminal history records by criminal justice agencies. These statutes and the implementing rules require that you obtain a Certificate of Eligibility from the Florida Department of Law Enforcement (FDLE) prior to requesting a court for an order to seal or expunge your non-judicial criminal history records, and that you provide the information required by this application process.

2.Please type or print all information, except signatures. Complete all required portions of the application and submit all required documents and the processing fee noted below, under Section A. Failure to disclose your social security number (SOC) may delay the processing time of your application. If your application is submitted without all the required information, documentation, or the processing fee, FDLE may reject your application.

3.Mailing information: Mail your completed application package and fee to the following address:

Florida Department of Law Enforcement

ATTN: Expunge/Seal Section

P.O. Box 1489

Tallahassee, Florida 32302-1489

4.Contact Information: FDLE’s Expunge/Seal Section – (850) 410-7870.

5.Optional Personal Review of your Florida criminal history record: If you have questions about what appears in your Florida criminal history record maintained by FDLE, you may wish to obtain a Personal Review of your record from FDLE, pursuant to Chapter 11C-8, FAC, before submitting this application form. The Personal Review is optional and is not required for FDLE to process your Application for Certification of Eligibility for expunction or sealing of your record. To obtain a Personal Review, please complete and submit the enclosed FDLE Fingerprint form and a letter to FDLE at the address above. If you submit the fingerprint form and a letter for your Personal Review, please DO NOT send in the APPLICATION or the $75.00 processing fee until the Personal Review is completed; the results of your personal review may influence your decision to request the expunction or sealing of your criminal history record.

SECTION A: FOR ALL APPLICANTS

1.Complete every part of SECTION A. Make sure your signature, as the applicant, is notarized.

2.If you were given a Notice to Appear and not physically arrested for the charge(s), indicate the date of the Notice to Appear in the box marked “Date of Arrest.”

3.NON-REFUNDABLE Processing Fee: Submit with your application a money order or Cashier’s check in the amount of $75.00, made payable to the Florida Department of Law Enforcement (FDLE).

4.Submit the attached fingerprint form with your fingerprints, as part of your application packet. This form must be completed by authorized personnel at a law enforcement or criminal justice agency, using only the attached FDLE Fingerprint form. (If you have obtained a Personal Review; send the fingerprint card back with the enclosed fingerprint form, please resubmit the same form for the Expunge/Seal “Certificate of Eligibility” application.)

5.Provide a certified copy of the final disposition(s) for each of the charges you list on your application. Dispositions can usually be obtained from the office of the Clerk of Courts in the county where you were charged. For Pretrial Intervention and other Diversion programs, a certified letter of completion from the State Attorney or Statewide Prosecutor may substitute for a certified disposition. If you received probation for any of the charges, you must also submit a certified copy of the termination of your probation.

SECTION B: FOR EXPUNCTION APPLICANTS ONLY

1.Submit the application to the State Attorney or Statewide Prosecutor for completion of SECTION B

only if you are applying to have your records EXPUNGED. NOTE: In addition to proper completion of Section B, you must also submit the certified copies of disposition(s) and termination of probation required under Section A.

SECTION C: FOR FDLE USE ONLY

REASONS AN APPLICATION FOR CERTIFICATE OF ELIGIBILITY TO SEAL OR EXPUNGE A CRIMINAL HISTORY RECORD WILL BE DENIED

Pursuant to Sections s.943.0585 and s.943.059, Florida Statutes, a Certificate of Eligibility to expunge or seal a criminal history record cannot be issued under any of the following circumstances:

1.The criminal history record reflects that you have been adjudicated guilty of a criminal offense or comparable ordinance violation or adjudicated delinquent for committing any felony or a misdemeanor specified in s.943.051(3)b. Certain driving violations are classified as criminal, such as DUI, reckless driving, and (with some exceptions) driving while license is suspended/canceled/revoked.

2.The criminal history record reflects that you have been adjudicated guilty of or adjudicated delinquent for committing one or more of the acts stemming from the arrest or alleged criminal activity to which the application pertains.

3.The criminal history record reflects that you have received a prior sealing or expunction of a criminal history record under s.943.0585, s.943.059, former s.893.14, former s.901.33, former s.943.058, or from any jurisdiction outside the state.

4.The criminal history record to which the application pertains relates to a violation of s 393.135, s. 394.4593, s.787.025, chapter 794, s.796.03, s.800.04, s.810.14, s.817.034, s.825.1025, s.827.071, chapter 839, s.847.0133, s.847.0135, s.847.0145, s.893.135, s.916.1075, a violation enumerated in s.907.041, or a violation of any offense qualifying for registration as a sexual predator under s.775.21 or for registration as a sexual offender under s.943.0435, Fla. Stat., with a finding of guilt, or a plea or guilty or nolo contendre (without regard to whether adjudication was withheld).

5.The criminal history record reflects that you have another petition to seal or expunge pending before a court of competent jurisdiction.

6.The criminal history record reflects that the court supervision applicable to the disposition of the arrest or alleged criminal activity to which the application pertains has not been completed.

7.[For expunction only] The criminal history record reflects that some or all of the charges related to the arrest or criminal activity to which the application pertains were not dismissed prior to trial, adjudication, or the withholding of adjudication, If no other disqualification applies, the record would be eligible to be sealed.

PLEASE NOTE: The Governor and Cabinet of Florida, acting in the capacity of the Board of Executive Clemency, declared on June 10, 1999, that the granting of a full pardon does not remove any condition of ineligibility for sealing or expunging a criminal history record which would otherwise be imposed by a conviction or withholding of adjudication pursuant to Sections 943.0585 and 943.059, Florida Statutes, and, acting in the capacity of agency head of the Department of Law Enforcement, the Board directed FDLE to deny a Certificate of Eligibility to any person receiving a pardon who is otherwise ineligible for the sealing or expunging of the person’s criminal history record.

DISQUALIFYING CHARGES FOR EXPUNCTION/SEALING

A request for a certificate of eligible for an expunction or sealing of a criminal history record will be denied if the defendant was found guilty or pled guilty or nolo contrendere, even if the adjudication was withheld, on any violation of the following:

Offenses listed in S.907.041, F.S.

1.Arson

2.Aggravated Assault

3.Aggravated Battery

4.Illegal use of explosives

5.Child abuse or Aggravated Child Abuse

6.Abuse of an elderly person or disabled adult, or aggravated abuse of an elderly person or disabled adult

7.Aircraft piracy

8.Kidnapping

9.Homicide

10.Manslaughter

11.Sexual Battery

12.Robbery

13.Carjacking

14.Lewd, lascivious, or indecent assault or act upon or in the presence of a child under the age of 16 years

15.Sexual activity with a child, who is 12 years of age or older but less than 18 years of age, by or at solicitation of a person in familial or custodial authority

16.Burglary of a dwelling

17.Stalking of Aggravated Stalking

18.Act of Domestic Violence, as defined in s.741.28

19.Home-invasion Robbery

20.Act of Terrorism as defined by s.775.30

21.Attempting or conspiring to commit any of the above crimes

22.Manufacturing any substances in violation of chapter 893

S.393.135, F.S.

Sexual misconduct with developmentally disabled person and related offenses

S.394.4593, F.S.

Sexual misconduct with mentally ill person and related offenses

S.787.025, F.S.

Luring or enticing a child

Chapter 794, F.S.

Sexual Battery and related offense

S.796.03, F.S.

Procuring person under 18 for prostitution

S.800.04, F.S.

Lewd or lascivious offenses committed upon or in the presence of persons less than 16 years of age

S.810.14, F.S.

Voyeurism

S.817.034, F.S.

Florida Communication Fraud Act

(Scheme to Defraud or Organized Fraud, as defined in s.817.034, F.S.)

S.825.1025, F.S.

Lewd or lascivious offense upon or in presence of elderly person or disabled adult

S.827.071, F.S.

Sexual performance by a child

Chapter 839, F.S.

Offenses by Public Officers and Employees

S.847.0133, F.S.

Showing, etc., obscene literature to minor

S.847.0135, F.S.

Computer pornography

S.847.0145, F.S.

Selling or buying of minors

S.893.135, F.S.

Trafficking in controlled substances

S.916.1075

Sexual misconduct with mentally deficient or mentally ill defendant and related offenses

A violation of any offense qualify for registration as a sexual predator under s.775.21 or for registration as a sexual offender under

s.943.0435.

All references are from Florida Statutes

FINGERPRINTS FOR

APPLICATION FOR CERTIFICATION OF ELIGIBILITY

Name:

 

Last________________________________

First _______________________Middle _________________________

Alias(aka)

 

Name: Last_________________________

First _______________________Middle _________________________

 

Place of

RACE: __ SEX:___ DOB: _______ * SOC: __________________________ Birth:__________________________

Please mail completed application and fingerprints to:

FDLE, P.O. Box 1489, Tallahassee, FL 32302, Attn: Expunge/Seal Section

Signature of official taking fingerprints: _____________________________________ ORI: _______________________________

Signature of person fingerprinted: _________________________________________________ Date: ______________________

1. R. Thumb

2. R. Index

3. R. Middle

4. R. Ring

5. R. Little

6. L. Thumb

7. L. Index

8. L. Middle

9. L. Ring

10. L. Little

Left Four Fingers Taken Simultaneously

L. Thumb

R. Thumb

Right Four Fingers Taken Simultaneously

Social Security Number, this information is voluntary; failure to disclose may delay the processing time of your application.

DID YOU REMEMBER TO:

Complete the application? Did you Sign and date the application in front of a notary?

Provide a certified (stamped copy) disposition of your case you want to have sealed/expunged?

Include your name, race/sex, date of birth, social security number and signature on the fingerprint form?

Provide a $75.00 check or money order made payable to FDLE? Did you sign and completely fill out the check or money order?

Include an Attorney’s letterhead, if you (applicant) are represented by an attorney?

Make copies of your application and documents for your records?

For Expunge Applicants only: Is Section B completed and signed by the State Attorney’s Office?

For Juvenile Expunge Applicants only: Is Section B completed and signed by the State Attorney’s Office?

FDLE asks that you provide your social security number (SSN). The decision to provide your SSN is at your option, and if you provide your SSN, FDLE will use it for purposes of identification, and may share the information with other agencies for the same purpose. FDLE’s request for your SSN is authorized by state law because use of it is imperative for FDLE to fulfill its lawful duties and responsibilities. Your failure to provide your SSN may result in a delay in processing your application or request.

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