Fill and Sign the Petition Sex Offender Form

Original Case Name State of ________________ v. _____________________ Case Number: _____________________ CHECK LIST FOR PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION (Complete this checklist if you were younger than 18 at the time of the disposition or adjudication. ) Please provide the following names and addresses: Treatment Provider(s) ___________________________________________ ____________________________________________ Name of Treatment Provider Name of Treatment Provider ___________________________________________ ____________________________________________ Address of Treatment Provider Address of Treatment Provider ___________________________________________ ____________________________________________ City State Zip Code City State Zip Code Name of Treatment Provider Name of Treatment Provider ___________________________________________ ____________________________________________ Address of Treatment Provider Address of Treatment Provider ___________________________________________ ____________________________________________ City State Zip Code City State Zip Code If supervised by probation, parole, or the Division of Youth Corrections, please complete the following: ___________________________________________ ____________________________________________ Probation Officer Division of Youth Corrections ___________________________________________ ____________________________________________ Address Address ___________________________________________ ____________________________________________ City State Zip Code City State Zip Code ___________________________________________ Parole Officer ___________________________________________ Address ___________________________________________ City State Zip Code IF YOU NEED ADDITIONAL SPACE CONTINUE ON THE BACK OF THE FORM. JDF 460 R7/06 CHECK LIST FOR PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION