Microsoft Word - BOOKLET 1 FINAL caps lock title.docx

Greater Boston Legal Services, 197 Friend Street, Boston, MA 02114

If you have past or present criminal cases filed against you in court, you have a

criminal record known as a CORI (Criminal Offender Record Information). You

may be able to seal your closed criminal cases if the charges are very old even

if you were found guilty. The first step in trying to seal records is to get a copy

of your CORI report. A model form is attached along with a blank form you can

use to get a copy of your CORI by mail.

GETTING YOUR CORI REPORT BY MAIL

STEP ONE

To request your report by mail, fill out a PERSONAL MASSACHUSETTS CRIMINAL RECORD

REQUEST FORM and sign it in front of a notary public. A blank form is attached which you can

use to request your CORI report.

STEP TWO

If you cannot afford to pay the $25 fee for a copy of your CORI, you may be eligible for a waiver

of the fee. If you receive public assistance such as MassHealth, SSI, T-ADFC, Mass. Veterans

Benefits, or EAEDC, you are automatically eligible for a fee waiver. To get a fee waiver, you must

fill out an AFFIDAVIT OF INDIGENCY. A blank form you can use is attached to this booklet. An

income chart is included in this booklet so you can figure out if you qualify for waiver of the fee.

STEP THREE

Put your PERSONAL MASSACHUSETTS CRIMINAL RECORD REQUEST FORM, AND a $25 money

order payable to the Commonwealth of Massachusetts OR the AFFIDAVIT OF INDIGENCY if you

qualify for a waiver of the $25 fee in an envelope and mail it to the:

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200

Chelsea, MA 02150

ATTN: CORI Unit

GETTING YOUR REPORT ONLINE

iCORI. You can also get a copy of your CORI report on the internet if you have a Massachusetts

driver’s license or a Mass ID issued by the Registry of Motor vehicles. If you receive public

assistance or have income at or below 125% of the poverty guidelines, you do not have to pay a

$25 fee if you check off “yes” when you are asked if you are indigent and answer questions. The

link to the website is: https://www.mass.gov/how-to/request-cori-as-an-individual

BOOKLET 1

HOW TO GET A COPY OF YOUR CRIMINAL RECORD (CORI)

DIRECTIONS FOR FILLING OUT “AFFIDAVIT OF INDIGENCY”

AND “SUPPLEMENT TO AFFIDAVIT OF INDIGENCY”

1. Fill out the forms carefully because the forms are “signed under the penalties of perjury.” You must

sign, date and fill out your name and mailing address on the applicable forms.

2. Box 1. If you get public assistance in the form of MassHealth (Medicaid), SSI, T-AFDC, Mass. Veterans

Benefits, or EAEDC, check off box “1” on the Affidavit of Indigency and circle the benefit(s) you get.

However, you do NOT need to fill out the Supplement to Affidavit of Indigency form.

3. Box 2. If you do not get these public assistance benefits, but have income (after taxes) that is equal

to or less than 125 percent of the federal poverty guidelines, you can check off box “2” on the

Affidavit of Indigency. To find out whether your income is equal to or less than the poverty

guidelines, look at the chart below. You also must list the amount of your income and how many

people you support on the Affidavit of Indigency.

4. Box 3. If your income is over the poverty guidelines, but you cannot pay the $25 fee for your CORI

without depriving yourself or dependents of the necessities of life such as food, shelter and clothing,

you can check off box “3” on the Affidavit of Indigency. You also must list the amount of your

income, your occupation and where you work, and source of your income if unemployed.

Size of Family Unit

(2018) 125% of Poverty Threshold

$15,175

$20,575

$25,975

$31,375

$36,775

$42,175

$47,975

$52,975

For family units with more than 8 members add $5,400/year for each additional member.

IMPORTANT. Please note that the federal poverty guidelines are updated EVERY year, usually by

spring. The poverty guidelines below are up to date as of October 10, 2018, but the guidelines will

likely change later on this year. Check www.masslegalhelp.org on the internet for updates on the

poverty guidelines.

LEGAL HELP FOR LOW INCOME PEOPLE

 Call the Eastern Regional Legal Intake (ERLI) at 617-603-1700 if you need legal help and you live in

the Boston area. You’ll be screened for eligibility for an intake for Greater Boston Legal Services

(GBLS). GBLS is not able to take every case, but ERLI or GBLS may be able to offer advice or refer you

to other resources to help you solve your problem.

 To find a legal aid program serving people outside of Boston or near you, go to:

www.masslegalhelp.org

 Read other booklets in this series: https://www.gbls.org/cori_record_sealing_booklets

Know Your CORI Rights—Sealing and Expungement of Criminal Offender Record Information

(This booklet is the most detailed, contains all the forms and discusses all topics below)

Booklet 1: How to Get a Copy of Your Criminal Record (CORI)

Booklet 2: How to Seal Old Criminal Convictions

Booklet 3: Sealing Cases that Ended Without a Conviction or First Time Drug Offenses

Booklet 4: Representing Yourself in Court after Filing a Petition to Seal Criminal Cases

Booklet 5: One Stop CORI Sealing in Boston Municipal Court

Booklet 6: What You Should Know about Drivers’ Licenses and Drug Convictions

Booklet 7: How to Seal or Expunge Decriminalized Marijuana Cases

Booklet 8: Avoiding Guilty Pleas and Criminal Case Dispositions that Give You Life-Time Criminal

Records

Booklet 9: How to Expunge Juvenile and Criminal Records

IMPORTANT. This information is provided as a public service by Greater Boston Legal

Services and does not constitute legal advice which can only be given to you by your own

attorney. This booklet relates only to Massachusetts state court records and the laws in

effect as of October 10, 2018.

BLANK FORMS

YOU CAN FILL IN AND USE

THE COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200, Chelsea, MA 02150

TEL: 617-660-4640 | TTY: 617-660-4606

MASS.GOV/CJIS



CriminalOffenderRecordInformation(CORI)PersonalRequestForm



IfyouhaveavalidMassachusettsI.D.ordriver’slicenseandarenotsubmittinganindigencywaiver,youmaysubmityour

CORIrequestonlineatMass.gov/CJIS.ThisformisonlytobeusedtorequestyourownpersonalCORIinformation.In

Massachusetts,itisillegalforanemployeroranyotherentitytorequiresomeonetoprovideacopyofhis/herpersonal

CORI.



AmoneyorderorbankissuedCashier’sorTreasurer’scheckintheamountof$25.00madeouttotheCommonwealthof

Massachusettsmustbesubmittedwiththisform.Pleasenotethat thesearetheonlyacceptableformsof payment.Do

notsendcash,personalchecks,orbusinesschecks.Thisform,along

withpaymentorindigencywaiver,mustbemailed

totheaddressabove,Attn:CORIUnit.



REQUESTINFORMATION



* Areyousubmittinganindigencywaiver? ☐Yes ☐No

 

Pleasenote:Youwillneedtosubmitanindigencywaiverifyouareindigent.Theindigencywaiverformcanbefound

athttp://www.mass.gov/eopss/docs/chsb/affidavit‐of‐indigency.pdf.



RequestorDetails

Pleasetypeorprintclearly.Itemsmarkedwithanasterisk(*)MUSTbecompleted.



* FirstName: _______________________________________________________ MiddleInitial: _________________

* LastName: _______________________________________________________ Suffix(Jr.,Sr.,etc): _____________

* DateofBirth(MM/DD/YYYY): ______________ ProbationCentralFile(PCF)Number(s)(ifknown): ________________

* LastSIXdigitsofyourSocialSecurityNumber:______‐‐____________ ☐Idonothavea

SocialSecurityNumber

 Father’sFirstName: ____________________________ Father’sLastName: __________________________________

 Mother’sFirstName: ___________________________ Mother’sLastName: _________________________________

 ☐Pleasecheckthisboxifyouwould ALSOliketorequestyourpersonalCORIwithyourformerlastname(s):

 FormerLastName1: _______________________________________________________________________________



 FormerLastName2: _______________________________________________________________________________



 FormerLastName3: _______________________________________________________________________________



 FormerLastName4: _______________________________________________________________________________



MailingAddress



* StreetAddress:___________ ______________________________________________________________________ ___

 Apt.#orSuite:______________ *City:___________ _______________ *State: ________ *Zip:_______________ 

 PersonalPhoneNumber:____________________________________________________________________________

 EmailAddress: ____________________________________________________________________________________

***PLEASENOTE:IfyouarerequestingyourCORIforimmigrationpurposes,andyouhaveadditionalpaperwork

regardingthenamesrequested,pleas eattachacopyofthepaperworkto

thisform.***



THE COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200, Chelsea, MA 02150

TEL: 617-660-4640 | TTY: 617-660-4606

MASS.GOV/CJIS



PersonalCORIRequestAuthorization



Iherebyswear,underpenaltiesofperjury,thattheinformationIhaveprovidedaboveistruetothebestofmy

knowledgeandbelief.



___________________________________________________________________ ____________________________

SignatureofIndividualAuthorizingCORIRequest Date



AuthenticationofSignature

PleasenotethatALLfieldsinthissectio nmustbecompletedbytheNotaryPublic.Thissectiondoesnotneedtobe

completedifyouarecurrentlyincarcerated;pleaseproceedtothenextsection.

 

On this ______ day of ___________, 20____, before me, the undersigned Notary Public, personally appeared

_______________________(nameofCORIrequestor)andprovedtomethroughsatisfactoryevidenceofidentification,

whichwas______________________(Ex:Driver’slicense,passport,etc.),tobethepersonwhosenameissignedonthe

precedingorattacheddocumen t,

andacknowledgedtomethat(he)(she)signeditvoluntarilyforitsstatedpurpose.



_____________________________________________________ _________________________________

SignatureofNotaryPublic(No tarystamporsealisalsorequired) DatemyCommissionexpires



CorrectionalFacilityInformation

Ifyouarecurrentlyincarcerated,acorrectionalfacilityofficialMUSTcompletethefollowingsection.



_____________________________________________________ _________________________________

 NameandrankofCorrectionalFacilityOfficial(Pleaseprint.) PhoneNumber



 

__________________________________________________________________________________________________

 AddressofCorrectionalFacility



_____________________________________________________ _________________________________

 SignatureofCorrectionalFacilityOfficial Date



THE COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200, Chelsea, MA 02150

TEL: 617-660-4640 | TTY: 617-660-4606

MASS.GOV/CJIS



AffidavitofIndigency

(ToBeSubmittedwithPersonalRequestForm)



Youoryourclient(ifyouaresubmittingapersonalCORIrequestonbehalfofaclient),maybeeligibleforawaiverofCORI

requestfee.Inorder toapply,pleasecompletethisaffidavitofindigency.Pleasenote,youmustselecttheoptionbelow

thatmostcloselydescribesyouor

yourclient'sfinancialstatus.



RequestorDetails

Pleasetypeorprintclearly.Itemsmarkedwithanasterisk(*)MUSTbecompleted.



* FirstName: _______________________________________________________ MiddleInitial: _________________



* LastName: _______________________________________________________ Suffix(Jr.,Sr.,etc): _____________



* StreetAddress:___________ ______________________________________________________________________ ___



 Apt.#orSuite:______________ *City:___________ _______________ *State: ________ *Zip:_______________ 



IndigencyDetails



*PursuanttoM.G.L.c.6,§172A,Iswear(oraffirm)asfollows:IAMINDIGENTinthat:(select"yes"toatleastoneoption)



1. Doyoureceivepublicassistance?

 ☐ Yes ☐ No



Ifyes,selecttheprogramsyoureceiveassistancefrom:

☐MassachusettsTransitionalAidtoFamilieswithDependentChildren(TAFDC)

☐FederalSupplementSecurityIncome(SSI)

☐EmergencyAidtoElderly,DisabledandChildren(EAEDC)

☐Medicaid(MassHealth)

☐MassachusettsVeterans'Programs



2. Is your income 125% or less of the current poverty threshold published in the Federal Register by the U.S.

DepartmentofHealthandHumanServices?

 ☐ Yes ☐ No



3. CanyoupaytheCORIfeewithoutdeprivingyourselforyourdependentsofthenecessitiesoflife?

 ☐ Yes ☐ No



Ifyes,youmustcompletetheseboxes:

GrossMonthlyIncome:______________GrossIncomeforthePastTwelveMonths: ________________

Ifemployed,pleaselistyouroccupationandemployer’snameandaddress: _______________________

_____________________________________________________________________________________

Ifunemployed,pleaselistyoursourceofincome:_____________________________________________



4. Areyoucurrentlyincarcerated?

 ☐ Yes ☐ No



IrequestthattheDepartmentofCriminalJusticeInformationServiceswaivethefeeforaPersonalCriminalRecord

Information(CORI)requestunderpenaltyofperjury.



___________________________________________________________________ ____________________________

SignatureofIndividualMakingCORIRequest Date