Case Name _____________________ v. ______________________ Case Number: _______________ CHECK LIST FOR PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION To enable the Court to have the accurate information for the Petition to Discontinue Sex Offender Registration, the Petitioner needs to provide the following names and addresses: All Law Enforcement Agencies that you have registered with: ___________________________________________ Name of Agency ____________________________________________ Name of Agency ___________________________________________ Address of Agency ____________________________________________ Address of Agency ___________________________________________ City State Zip Code ____________________________________________ City State Zip Code ___________________________________________ Name of Agency ____________________________________________ Name of Agency ___________________________________________ Address of Agency ____________________________________________ Address of Agency ___________________________________________ City State Zip Code ____________________________________________ City State Zip Code 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 Were you supervised by probation or the Division of Youth Corrections? If yes please list below. ___________________________________________ Probation Officer ____________________________________________ Division of Youth Corrections ___________________________________________ Address ____________________________________________ Address ___________________________________________ City State Zip Code ____________________________________________ City State Zip Code IF YOU NEED ADDITIONAL SPACE CONTINUE ON THE BACK OF THE FORM JDF 460 R8/02 CHECK LIST American LegalNet, Inc. www.USCourtForms.com