Fill Out Your Delaware Pardon Application Form

State of Delaware

BOARD OF PARDONS

DELAWARE BOARD OF PARDONS CHECKLIST

YOU MUST COMPLETE STEPS 1 AND 2 BEFORE PROCEEDING WITH THE APPLICATION PROCESS. THESE TWO STEPS WILL TAKE SEVERAL WEEKS! ALL APPLICATIONS MUST BE FILLED IN ONLINE AND THEN PRINTED FOR SUBMISSION.

Step 1

Request your Certified Criminal History which can be obtained by submitting a fee along with your fingerprints to State Bureau of Identification. For specific information and locations please contact them at (302) 739-5871. Please be advised that your Criminal History Report cannot be older than 3 months at the time your application is submitted. This document must be attached to your application.

Step 2

Request Certified Court Dockets and Sentencing Orders and/or Disposition Records for all ADULT dispositions listed as guilty, unknown, unobtainable, transferred or pending. Additionally, you must submit certified copies of financial information on outstanding fines, costs, fees and restitution. Contact the courts in the county associated

with the offense(s) for further information on how to request the documents. These documents must be attached to

your application.

Step 3

Once you have received your Certified Criminal History and your Certified Court Dockets and Sentencing Orders, complete the page titled “Criminal History Review Form”.

Step 4

Compare your offense(s) from your “Criminal History Review Form” to the offense(s) listed on the “Offenses that

Require a Mental Health Report.” If jail time was served in relation to an offense(s) that require a mental health report,

you will have to provide a Psychiatric or Psychological Evaluation from a licensed professional of your choice. Any psychologist or psychiatrist performing an evaluation must submit the information requested in Rule 9, paragraph (c) listed on page 12 of the Rules of the Board of Pardons.

Step 5

Complete the entire Delaware Board of Pardons Application for Pardon by typing in your responses online and then printing all forms once complete.

Step 6

Complete the Affidavit of Mailing by typing in your responses online and then printing once complete. This form must be notarized. Include the original Affidavit in your application and mail copies to the individuals listed on the form.

Step 7

To request a Telephonic hearing due to hardship, please complete and submit the Hardship Form with the application. Please be aware that this request is subject to approval.

Step 8

Assemble all your documents to include the criminal history report and the court dockets and attach them to the appropriate sections as specified in the application. Once assembled, make one copy of EVERYTHING (so you will have a total of 2 complete packets). Use a paper clip or binder clip to attach your documents together for each packet. Stapled

documents will not be accepted.

Step 9

Keep one copy of your application packet for your records and mail the original packet to:

Board of Pardons

Secretary of State’s Office

401 Federal Street, Suite 3

DOVER, DE 19901

If you have any questions, contact the Board of Pardons at 302-739-4111, option 2. You can also visit us online at

pardons.delaware.gov.

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ｕｈｗｘｕｑｈｇ１＃ Ｗｋｌｖ＃ｏｌｖｗ＃ｚｌｏｏ＃ｖｈｕｙｈ＃ｄｖ＃ｄ＃ｊｘｌｇｈ＃ｄｖ＃｜ｒｘ＃ｆｒｐｓｏｈｗｈ＃ｗｋｈ＃ＧＨＯＤＺＤＵＨ＃ＥＲＤＵＧ＃

ＲＩ＃ＳＤＵＧＲＱＶ＃ＤＳＳＯＬＦＤＷＬＲＱ

５１＃ ＃＃Ｄｇｇｕｈｖｖ＝＃ｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

９１＃ ＃＃Ｖｗｄｗｈ＃ｈｙｈｕ｜＃ｒｗｋｈｕ＃ｑｄｐｈ＃ｅ｜＃ｚｋｌｆｋ＃｜ｒｘ＃ｋｄｙｈ＃ｅｈｈｑ＃ｎｑｒｚｑ／＃ｌｑｆｏｘｇｌｑｊ＃ｗｋｈ＃ｑｄｐｈ＃ｘｑｇｈｕ＃ｚｋｌｆｋ＃｜ｒｘ＃

＃＃＃＃＃＃＃ｚｈｕｈ＃ｆｒｑｙｌｆｗｈｇ＃＋I.E.／＃ｌｑｆｏｘｇｈ＃｜ｒｘｕ＃ｐｄｌｇｈｑ＃ｑｄｐｈ／＃ｑｄｐｈ＃ｅ｜＃ｄ＃ｉｒｕｐｈｕ＃ｐｄｕｕｌｄｊｈ／＃ｄｏｌｄｖｈｖ／＃ｄｑｇ＃＃

ｑｌｆｎｑｄｐｈｖ，１＃

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＃＃＃＃＃＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

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：１＃Ｄｗｗｒｕｑｈ｜＃Ｌｑｉｒｕｐｄｗｌｒｑ＃ﾱ＃Ｄｕｈ＃｜ｒｘ＃ｕｈｓｕｈｖｈｑｗｌｑｊ＃｜ｒｘｕｖｈｏｉＢ＃＃

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＼ｈｖ＃＃＃＃ Ｑｒ／＃ｌｉ＃ｑｒ＃｜ｒｘ＃ｐｘｖｗ＃ｓｕｒｙｌｇｈ＃｜ｒｘｕ＃ｄｗｗｒｕｑｈ｜ﾶｖ＃ｌｑｉｒｕｐｄｗｌｒｑ１＃Ｒｗｋｈｕｚｌｖｈ／＃ｓｕｒｆｈｈｇ＃ｗｒ＃ｗｋｈ＃ｑｈ｛ｗ＃ｖｗｈｓ１＃＃

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Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｑｄｐｈ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

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Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｄｇｇｕｈｖｖ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

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Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｓｋｒｑｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

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Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｈｐｄｌｏ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃

ＱＲＷＨ＝＃Ｓｏｈｄｖｈ＃ｆｒｑｗｄｆｗ＃ｗｋｈ＃Ｅｒｄｕｇ＃ｒｉ＃Ｓｄｕｇｒｑｖ＃＋６３５０：６＜０７４４４／＃ｒｓｗｌｒｑ＃５，＃ ｌｐｐｈｇｌｄｗｈｏ｜＃ｌｉ＃ｗｋｈｕｈ＃ｌｖ＃ｄ＃ｆｋｄｑｊｈ＃

ｒｉ＃ｄｇｇｕｈｖｖ＃ｖｌｑｆｈ＃ｗｋｌｖ＃ｚｌｏｏ＃ｄｉｉｈｆｗ＃｜ｒｘｕ＃ｅｈｌｑｊ＃ｑｒｗｌｉｌｈｇ＃ｒｉ＃ｄ＃ｋｈｄｕｌｑｊ＃ｇｄｗｈ＃ｒｕ＃ｕｈｆｈｌｙｌｑｊ＃ｄｑ｜＃ｒｗｋｈｕ＃ｆｒｕｕｈｖｓｒｑｇｈｑｆｈ１＃

REASONS FOR SEEKING A PARDON

What are your reasons for seeking a pardon? Attach any supporting documents as evidence to support reasons due to extenuating circumstances. (Example: Denial letter due to failed background check or written regulations regarding criminal convictions preventing you from services)

Pending Proceedings: Do you have pending any judicial or administrative proceedings with the federal, state, or local governments? Yes No. If yes, state the full jurisdiction in which the proceeding is pending, the nature of the dispute, and the current status of the matter.

Describe below any community/charitable activities you are involved in and your duties. (You may attach any certificates or documents)

References may be attached to this page

Attach supporting documents as evidence to support reasons due to extenuating circumstances.

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ＤＩＩＬＧＤＹＬＷ＃ＲＩ＃ＰＤＬＯＬＱＪ＃

＃

＃

ＶＷＤＷＨ ＲＩ ＧＨＯＤＺＤＵＨ

ＧＨＯＤＺＤＵＨ＃ＥＲＤＵＧ＃ＲＩ＃ＳＤＵＧＲＱＶ＃

＃

＃Ｄｓｓｏｌｆｄｑｗ＃Ｑｄｐｈ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂＧｄｗｈ＃ｒｉ＃Ｅｌｕｗｋ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃

＃

＃Ｗｋｈ＃ｄｅｒｙｈ＃ｄｓｓｏｌｆｄｑｗ＃ｋｄｖ＃ｉｌｏｈｇ＃ｄ＃ｓｈｗｌｗｌｒｑ＃ｉｒｕ＃ｄ＃ｓｄｕｇｒｑ＃ｚｌｗｋ＃ｗｋｈ＃Ｅｒｄｕｇ＃ｒｉ＃Ｓｄｕｇｒｑｖ＃＋ﾳＥｒｄｕｇﾴ，＃ｌｑ＃ｗｋｈ＃Ｖｈｆｕｈｗｄｕ｜＃ ｒｉ＃Ｖｗｄｗｈﾶｖ＃Ｒｉｉｌｆｈ／＃７３４＃Ｉｈｇｈｕｄｏ＃Ｖｗｕｈｈｗ／＃Ｖｘｌｗｈ＃６／＃Ｇｒｙｈｕ／＃ＧＨ＃４＜＜３４１＃Ｗｋｈ＃ｓｈｗｌｗｌｒｑ＃ｚｌｏｏ＃ ｅｈ＃ｋｈｄｕｇ＃ｄｗ＃ｗｋｈ＃ｈｄｕｏｌｈｖｗ＃

＃ｓｒｖｖｌｅｏｈ＃ｇｄｗｈ＃ｄｖ＃ｇｈｗｈｕｐｌｑｈｇ＃ｅ｜＃ｗｋｈ＃Ｅｒｄｕｇ１＃ Ｋｈｄｕｌｑｊｖ＃ｄｕｈ＃ｋｈｏｇ＃ｄｗ＃ｗｋｈ＃Ｎｈｑｗ＃Ｆｒｘｑｗ｜＃Ｆｒｘｕｗｋｒｘｖｈ／＃Ｆｒｘｕｗｕｒｒｐ＃；／＃ ７４７＃Ｉｈｇｈｕｄｏ＃Ｖｗｕｈｈｗ／＃Ｇｒｙｈｕ／＃ＧＨ＃ ４＜＜３４１＃

Ｆｒｓｌｈｖ＃ｒｉ＃ｗｋｌｖ＃ｄｉｉｌｇｄｙｌｗ＃ｒｉ＃ｐｄｌｏｌｑｊ＃ｋｄ＃ｙｈ＃ｅｈｈｑ＃ｖｈｑｗ＃ｗｒ＝＃

４１＃ Ｗｋｈ＃Ｍｘｇｊｈ＋ｖ，＃ｚｋｒ＃ｓｕｈｖｌｇｈｇ＃ｄｗ＃ｗｋｈ＃ｖｈｑｗｈｑｆｌｑｊ＃ｋｈｄｕｌｑｊ＋ｖ，＃ｒｕ＃Ｓｕｈｖｌｇｌｑｊ＃Ｍｘｇｊｈ＋ｖ，＃

＃５１＃ Ｍｒｖｈｓｋ＃Ｕ１＃Ｅｌｇｈｑ／＃ＬＬＬ／＃Ｈｖｔ１＃Ｄｗｗｒｕｑｈ｜＃Ｊｈｑｈｕｄｏ／＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｍｘｖｗｌｆｈ／＃Ｆｄｕｙｈｏ＃Ｖｗｄｗｈ＃Ｅｘｌｏｇｌｑｊ／＃；５３＃Ｑ１＃Ｉｕｈｑｆｋ＃Ｖｗ１／＃

Ｚｌｏｐｌｑｊｗｒｑ／＃ＧＨ＃ ４＜；３４１＃

６１＃ Ｆｋｌｈｉ＃ｒｉ＃Ｓｒｏｌｆｈ＃ｌｑ＃ｗｋｈ＃ｆｌｗ｜２ｆｒｘｑｗ｜＃ｚｋｈｕｈ＃ｗｋｈ＃ｄｕｕｈｖｗ＋ｖ，＃ｚｄｖ２ｚｈｕｈ＃ｐｄｇｈ１＃＃Ｒｐｌｗ＃ｗｋｌｖ＃ｖｗｈｓ＃ｌｉ＃｜ｒｘ＃ｚｈｕｈ＃ｒｑｏ｜＃

ｄｕｕｈｖｗｈｇ＃ｅ｜＃Ｇｈｏｄｚｄｕｈ＃Ｖｗｄｗｈ＃Ｓｒｏｌｆｈ１＃

７１＃ Ｆｒｏｒｑｈｏ＃Ｑｄｗｋｄｑｌｈｏ＃ＰｆＴｘｈｈｑ／＃Ｖｘｓｈｕｌｑｗｈｑｇｈｑｗ／＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｓｘｅｏｌｆ＃Ｖｄｉｈｗ｜／＃Ｇｌｙｌｖｌｒｑ＃ｒｉ＃Ｖｗｄｗｈ＃Ｓｒｏｌｆｈ／＃

＃＃＃＃＃＃Ｓ１Ｒ１＃Ｅｒ｛＃７６３／＃Ｇｒｙｈｕ／＃ＧＨ＃ ４＜＜３６１＃ Ｕｈｄｖｒｑ＋ｖ，＃ｉｒｕ＃ｄｓｓｏ｜ｌｑｊ＝＃

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Ｒｉｉｈｑｖｈ＋ｖ，＃ｄｑｇ＃Ｇｄｗｈ＋ｖ，＃ｒｉ＃Ｄｕｕｈｖｗ＝＃

＃＃＃＃＃＃＃＃＃＃＃＃

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ＶＷＤＷＨ＃ＲＩ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃＃，＃

＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃，＃＃＃＃ＶＶ＃ ＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃

ＦＲＸＱＷ＼＃ＲＩ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃＃＃，＃

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Ｗｋｌｖ＃ｄｓｓｏｌｆｄｑｗ／＃ｅｈｌｑｊ＃ｖｚｒｕｑ／＃ｇｈｓｒｖｈｖ＃ｄｑｇ＃ｖｄ｜ｖ＃ｗｋｄｗ＃ｋｈ２ｖｋｈ＃ｌｖ＃ｄｗｗｈｖｗｌｑｊ＃ｗｋｄｗ＃ｄｏｏ＃ｖｗｄｗｈｐｈｑｗｖ＃ｆｒｑｗｄｌｑｈｇ＃ｌｑ＃ｋｌｖ２ｋｈｕ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｄｕｈ＃ｗｕｘｈ＃ ｄｑｇ＃ｆｒｕｕｈｆｗ＃ｌｑ＃ｈｙｈｕ｜＃ｕｈｖｓｈｆｗ／＃ｄｑｇ＃ｗｋｄｗ＃ｋｈ２ｖｋｈ＃ｋｄｖ＃ｑｒｗ＃ｖｘｓｓｕｈｖｖｈｇ＃ｄｑ｜＃ｌｑｉｒｕｐｄｗｌｒｑ＃ｗｋｄｗ＃ｐｌｊｋｗ＃ｄｉｉｈｆｗ＃ｗｋｌｖ＃ｄｓｓｏｌｆｄｗｌｒｑ１＃

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Ｖｚｒｕｑ＃ｗｒ＃ｐｈ＃ｅｈｉｒｕｈ＃ｐｈ＃ｗｋｌｖ＃ｂｂｂｂｂｂ＃ｇｄ｜＃ｒｉ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ／＃５３＃ｂｂｂｂｂｂｂｂｂｂ１＃

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ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃

＃＃＃＃＃＃＃＃＃＃Ｖｌｊｑｄｗｘｕｈ＃ｒｉ＃Ｑｒｗｄｕ｜＃Ｓｘｅｏｌｆ＃

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Ｐ｜＃ｆｒｐｐｌｖｖｌｒｑ＃ｈ｛ｓｌｕｈｖ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂ１＃＃＃＋ＶＨＤＯ，＃

＃ＬＰＳＲＵＷＤＱＷ＝＃Ｐｄｎｈ＃ｖｘｕｈ＃｜ｒｘ＃ｋｄｙｈ＃ｆｒｐｓｏｈｗｈｇ＃ｈｙｈｕ｜＃ｌｗｈｐ＃ｒｑ＃ｗｋｈ＃ｆｋｈｆｎｏｌｖｗ＃ｄｑｇ＃ｗｋｄｗ＃｜ｒｘｕ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｌｖ＃ｖｌｊｑｈｇ＃ｄｑｇ＃ｆｒｐｓｏｈｗｈ１ Ｄｑ｜＃ｐｌｖｖｌｑｊ＃ｌｑｉｒｕｐｄｗｌｒｑ＃ｚｌｏｏ＃ｖｌｊｑｌｉｌｆｄｑｗｏ｜＃ｇｈｏｄ｜＃ｓｕｒｆｈｖｖｌｑｊ１＃

REQUEST FOR A TELEPHONIC HEARING DUE TO HARDSHIP

Due to the circumstance(s) described below, the applicant is requesting that a telephonic hearing be allowed in place of a “personal appearance”.

Applicant Name _______________________________________ Date of Birth ___________________

Reason(s) petitioner has found that it would be a hardship to physically attend the hearing:

_________________________________________________________________________________

If an approval of hardship is made, the “Board” may require that you be available by phone at your scheduled time. Please provide a reliable telephone number that could be used to contact you for a possible telephonic hearing (___________)-__________________________________.