A LABAMA L AW E NFORCEMENT A GENCY Sex Offender Registration Unit Page 1 SO - 4 , 8 / 1 /201 7 Adult Sex Offender Homeless Acknowledgement & Registration The Alabama Sex Offender Registration and Community Notification Act 1 requires more frequent registration for adult homeless sex offenders. This document summarizes the additional responsibilities of an adult sex offender within Alabama that has indicated a Homeless Residency Status and requires the offender to provide location information for where the offender has res ided and plans to reside . Past Week Please provide a detailed description of the location or locations where you resided in the past week . Monday Tuesday Wednesday Thursday Friday Saturday Sunday Upcoming Week Please provide a detailed description of the location or locations where you plan to reside. Monday Tuesday Wednesday Thursday 1 24724715 - 20A - 1 et seq . , Code of Alabama 19 7 5, as amended by Act 201 7 - 4 14 American LegalNet, Inc. www.FormsWorkFlow.com A LABAMA L AW E NFORCEMENT A GENCY Sex Offender Registration Unit Page 2 Friday Saturday Sunday Special Duties for Adult Sex Offenders with a Homeless Residency Status You must appear in person and report any change in fixed residence to law enforcement where you are located /reside within three (3) business days upon any change in fixed residence. You must comply with all other registration and verification requirements listed in the Act. You must register all of the above registration information with the law enforcement agency where you reside once every 7 days on a day and time specified by the law enforcement agency . If you reside within the city limits of a municipality, you shall repo rt to the chief of police. If you reside outside of the city limits of a municipality, you shall report to the sheriff of the county. If you obtain a fixed residence that complies with the residency restrictions listed in the Act, you must appear in person within three (3) business days and update your registration information with local law enforcement in each county of residence. Any violation of the above provisions shall constitute a Class C felony. By signing below, I acknowledge that I have read the above information and responsibilities and that I am aware of all that is required of me under the Alabama Sex Offender Registration and Community Notification Act . If I fail to comply with any provision of the Act, I understand that I may be cha rged w ith a Class C felony in Alabama . I certify that all the information contained in this form is true and correct. Offender Registering Agency Printed Name Agency Name Social Security Number Signature Date of Birth Printed Name Signature Date Date American LegalNet, Inc. www.FormsWorkFlow.com