NDLSHC Page 1 of 3 Affidavit Prohibit Pub Access/Rev Jan 2020
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STATE OF NORTH DAKOTA IN DISTRICT COURT
COUNTY OF _________________________ ____________________ JUDICIAL DISTRICT
THE STATE OF NORTH DAKOTA ) PLAINTIFF, ) Criminal Case No. _____________________ ) vs. ) ) AFFIDAVIT IN SUPPORT OF MOTION TO ____________________________ ) PROHIBIT PUBLIC ACCESS DEFENDANT. )
I, ___________________________________________________________________, the
undersigned, state as follows:
1. I am the defendant in the above-captioned criminal case(s).
2. I was charged on ______________________________________________________ with
______________________________________________________________________________
_____________________________________________________________________________.
3. On _______________________________________________________, the charge(s)
against me was/were dismissed / I was acquitted of the charge(s).
4. In the above-captioned criminal case(s), the reason for dismissal of charge(s) /
acquittal was ________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
5. Because the records have remained available for public access, I have sustained or am
likely to sustain the following harms: _______________________________________________
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______________________________________________________________________________
NDLSHC Page 2 of 3 Affidavit Prohibit Pub Access/Rev Jan 2020
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Additional sheets are attached as Exhibit B.
NDLSHC Page 3 of 3 Affidavit Prohibit Pub Access/Rev Jan 2020
6. I declare, under penalty of perjury under the law of North Dakota, that everything I
stated in this Affidavit is true and correct.
STATE OF ) ) COUNTY OF _________________________ ) ss. ) COUNTRY OF _________________________ ) Signed on this _____ day of ___________________________, 20______.
________________________________________________ Defendant Signature
Printed Name
Address
City, State, Zip Code
Telephone Number