District Court ________________________ County, Colorado Court Address: PETITION OF: __________________________ (Name of party filing Petition) Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: Phone Number: FAX Number: Division: E-mail: Atty. Reg.#: Courtroom: PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION - NON-COLORADO CONVICTION OR JUVENILE ADJUDICATION OR DISPOSITION - NON-COLORADO Pursuant to §16-22-113, C.R.S., I ______________________________________________ (Petitioner), Petition the Court for an Order removing the requirement that I register as a sex offender. Information about the Petitioner: Full Name: ______________________________________________ Date of Birth: _____________________ (First, Middle, Last) Current Address: ____________________________________________________________________________ Home Phone Number: ___________________________ Cell Phone Number: ______________________ I request that this Petition to Discontinue Sex Offender Registration be set for hearing. As grounds for this Petition, I affirm the following to be true: (check applicable box) The statutory prohibitions regarding ineligibility to file this Petition as set forth at §16-22-113(3), C.R.S. do not apply to me; and On _______________________ (date) I successfully completed the terms and conditions of a deferred adjudication or deferred sentence for an offense involving unlawful sexual behavior or for an offense involving the factual basis of unlawful sexual behavior. The case has been dismissed. I have not been subsequently convicted or adjudicated for any offense involving unlawful sexual behavior; or I was less than 18 years of age at the time I was adjudicated a juvenile delinquent for an offense involving unlawful sexual behavior or for an offense involving the factual basis of unlawful sexual behavior. I have successfully completed the terms and conditions of my sentence related to that offense. I have not been subsequently convicted or adjudicated a juvenile delinquent for any offense involving unlawful sexual behavior. I am also petitioning to have my name removed from the Sex Offender Registry; or The offense for which I was required to register was a misdemeanor other than unlawful sexual contact or third degree sexual assault and it has been five years since my final release from the jurisdiction of the Court or discharge from the Department of Corrections. I have not been subsequently convicted or adjudicated for any offense involving unlawful sexual behavior; or The offense for which I was required to register was a class 4, 5, or 6 felony or was a class 1 misdemeanor of unlawful sexual contact or third degree sexual assault and it has been 10 years since my final release from the jurisdiction of the Court or discharge from the Department of Corrections. I have not been subsequently convicted or adjudicated for any offense involving unlawful sexual behavior; or JDF 473 R7/06 PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION - NON-COLORADO CONVICTION OR JUVENILE ADJUDICATION OR DISPOSITION - NON-COLORADO Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com The offense for which I was required to register was a class 1, 2 or 3 felony and it has been 20 years since my final release from the jurisdiction of the court or discharge from the Department of Corrections. I have not been subsequently convicted or adjudicated for any offense involving unlawful sexual behavior. I have registered as a sex offender with the following law enforcement agency or agencies: (Complete as many as applicable.) #1 #2 __________________________________________ __________________________________________________ Police or Sheriff’s Department Police or Sheriff’s Department ___________________________________________ __________________________________________________ Address Address ___________________________________________ __________________________________________________ City City State Zip Code State Zip Code #3 #4 ___________________________________________ __________________________________________________ Police or Sheriff’s Department Police or Sheriff’s Department ___________________________________________ __________________________________________________ Address Address ___________________________________________ __________________________________________________ City City State Zip Code State Zip Code Document must be signed before a notary public or sworn to before a deputy clerk. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge and belief. _______________________________________ ________________________ Petitioner’s Signature Date _______________________________________ _________________________ Attorney’s Signature Date Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ____________________, this ___________ day of _______________, 20 _____. My Commission Expires: ________________________ ___________________________________ Notary Public /Deputy Clerk JDF 473 R7/06 PETITION TO DISCONTINUE SEX OFFENDER REGISTRATION - NON-COLORADO CONVICTION OR JUVENILE ADJUDICATION OR DISPOSITION - NON-COLORADO Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com