APPLICATION TO RESTRICT OR TO REMOVE RESTRICTION ON DISSEMINATION OF SEX OFFENDER REGISTRATION INFORMATION JD-CR-123 Rev. 8-02 C.G.S. §§ 54-255, 54-258 CONNECTICUT JUDICIAL BRANCH SUPERIOR COURT www.jud.ct.gov INSTRUCTIONS TO CLERK 1. Do not accept this Application if the Applicant fails to submit a completed JD-VS-3, Notice of Application. 2. Get original court file and set down for hearing. 3. Give notice to prosecutor and applicant. 4. If application is granted, send copy to Department of Public Safety and to the agency having custody of the offender (DOC if incarcerated, PSRB if committed, CSSD if probation), if any. INSTRUCTIONS TO APPLICANT 1. Original and 1 copy to clerk of court. 2. Forward a copy to the prosecuting attorney for the offense for which restriction on dissemination of registration information is sought. 3. Complete the form below with information for the case in which the defendant was convicted or found not guilty by reason of mental disease or defect and for which restriction or removal of restriction and dissemination of registration information is sought. 4. If application is to remove restriction on dissemination, send copy to prosecuting attorney and defendant. 5. You must complete and attach form JD-VS-3, Notice of Application. TO: The Superior Court of the State of Connecticut IN RE: (Name of Defendant) ADDRESS OF DEFENDANT (Number, Street, Town and Apt. No.) DATE SENTENCED COURT SENTENCED AT (J.D. or G.A.) ADDRESS OF SENTENCING COURT (Number, street and town) ADDRESS OF APPLICANT (Number, street and town) DATE OF BIRTH (If known) DOCKET NO. FROM (Name of Applicant) APPLICATION TO RESTRICT DISSEMINATION OF REGISTRATION INFORMATION I, the undersigned Applicant, hereby request the court to order the Department of Public Safety to restrict the dissemination of registration information to law enforcement purposes only and to not make such information available for public access, in accordance with Connecticut General Statutes §§ 54-255 and 54-258, and state as follows: 1. I was convicted or found not guilty by reason of mental disease or defect of a violation of ("X" one): Connecticut General Statute § 53a-71(a)(1) (Sexual assault in the second degree by engaging in sexual intercourse with another person and such other person is thirteen years of age or older but under sixteen years of age and the actor is more than two years older than such person) between October 1, 1988 and June 30,1999 and I was under the age of nineteen years at the time of the offense. Connecticut General Statute § 53a-73a(a)(2) (Sexual assault in the fourth degree by subjecting another person to sexual contact without such other person's consent) between October 1, 1988 and June 30,1999. A criminal offense against a victim who is a minor, a nonviolent sexual offense or a sexually violent offense, as those terms are defined in Connecticut General Statute § 54-250, between October 1, 1988 and June 30,1999, where the victim of such offense was, at the time of the offense, under eighteen years of age and related to me within any of the degrees of kindred specified in Connecticut General Statute §46b-21. Publication of the registration information would likely reveal the identity of the victim within the community where the victim resides. Connecticut General Statute § 53a-70b (sexual assault in spousal or cohabiting relationship) between October 1, 1988 and June 30, 1999. Publication of the registration information would likely reveal the identity of the victim within the community where the victim resides. A crime between October 1, 1988 and September 30,1998, which requires registration under Connecticut General Statute sections 54-250 to 54-259, inclusive, and (1) served no jail or prison time as a result of such conviction or finding of not guilty by reason of mental disease or defect, (2) have not been subsequently convicted or found not guilty by reason of mental disease or defect of any crime which would require registration under Connecticut General Statute sections 54-250 to 54-259, inclusive, and (3) have registered with the Department of Public Safety in accordance with Connecticut General Statute sections 54-250 to 54-259, inclusive. 2. Dissemination of registration information to the public is not required for public safety for the following reason(s) (specify):. 3. I have notified the Office of Victim Services and the Department of Correction of this application. A completed form JD-VS-3, Notice of Application, is attached as proof of notice to the Office of Victim Services and to the Department of Correction. I have read the above and understand it. I agree with the foregoing statements. CONSENTED TO BY (Parent or Guardian) SIGNED (Applicant) DATE SIGNED DATE SIGNED X SIGNED (Attorney for Applicant) (PAGE 1 OF 2) American LegalNet, Inc. www.FormsWorkflow.com ORDER OF THE COURT The foregoing application is DENIED. The court, having found that dissemination of registration information is not required for public safety, and that the criteria set forth in the above application have been met, hereby GRANTS the foregoing application and orders the Department of Public Safety to restrict the dissemination of the registration information to law enforcement purposes only and to not make such information available for public access. SIGNED (Judge, Assistant Clerk) DATE SIGNED APPLICATION TO REMOVE RESTRICTION ON DISSEMINATION OF REGISTRATION INFORMATION I, the undersigned Applicant, hereby request the court to order the removal of the restriction on the Department of Public Safety's dissemination of registration information to law enforcement purposes only and prohibiting making such information available for public access, and state as follows: 1. The above-named defendant was convicted or found not guilty by reason of mental disease or defect of a violation of: ("X" one) Connecticut General Statute § 53a-70b (sexual assault in spousal or cohabiting relationship) A criminal offense against a victim who is a minor, a nonviolent sexual offense or a sexually violent offense, as those terms are defined in Connecticut General Statute § 54-250, where the victim of such offense was, at the time of the offense, under eighteen years of age and related to the defendant within any of the degrees of kindred specified in Connecticut General Statute § 46b-21. 2. ("X" one of the following and complete the requested information) Public safety requires that the Defendant's registration inform