Intake Form
Your Information
Your Name:
Your Email Address:
Address:
City / State / Zip
Phone Number
Date of Birth
Social Security No:
Driver's License Number:
Number of Felony Convictions
County where felony convictions occurred:
City in which you were convicted of a felony:
Date of Arrest:    Case Number:   
Date of Conviction:
Date Probation Ended:
Date Parole Ended:
Number of Felony Convictions
County where misdemeanor convictions occurred:
City in which you were convicted of a Misdemeanor:
Date of Arrest:    Case Number:   
Date of Conviction:
Date Probation Ended:
Are you presently facing any charges?:
Payment Information
Exact Name on Credit Card
Credit Card Type
Credit Card Number
Expiration Month:      Year:  
Enter quantity of each type of expungement you are requesting, then click on "Calculate Results"
NOTE: The total for each expungement will include a $125.00 filing fee.
Item Qty Price   Amount
Misdemeanor Expungement
inside of L.A. County		 $795.00
+ $125.00 filing fee		 $
Felony Expungement
inside of L.A. County		 $995.00
+ $125.00 filing fee		 $
Misdemeanor Expungement
outside of L.A. County		 $995.00
+ $125.00 filing fee		 $
Felony Expungement
outside of L.A. County		 $1,195.00
+ $125.00 filing fee		 $
Authorization for $250.00 Fee Per Conviction for Information Research

By checking the box to the left, I acknowledge that the expungement fees listed above assume that all of the information requested in the on line intake form has been provided. In the event that information is unavailable to the petitioner, I authorize the Law Offices of Rosen & Zimmerman to conduct the research necessary to obtain the information for an additional fee of $250.00 per conviction.
   Total: $
Please read
statement
at right and
check box
to proceed.

By checking the box to the left, I acknowledge that I understand that the Law Offices of Rosen & Zimmerman has not agreed to represent me in any matter and that in the event an offer of representation is made I will be offered a written retainer agreement signed by either Howard S. Rosen or Paul S. Zimmerman which will define the scope of my representation.
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