STATE OF HAWAI`I CIRCUIT COURT OF THE FIRST CIRCUIT SEX OFFENDER ADDENDUM CASE NUMBER: STATE OF HAWAI`I vs. (Defendant) 1. I understand that following the entry of my plea to the offenses set forth above, I am required to provide two blood samples to the appropriate authorities and I further understand that upon conviction, the law requires me to register as a sex offender with the attorney general and county chief of police for the rest of my life. 2. My lawyer has also informed me that I must provide: a. A recent photograph; b. Verified fingerprints; c. My name(s), alias(es), date of birth, Social Security Number, sex, race, height, weight, and hair and eye color; d. My current legal address and telephone number(s); e. Other legal addresses and telephone numbers where I am staying for a period of time more than ten (10) days (if different from my current legal address and telephone numbers); f. My future addresses and telephone numbers where I am planning to reside (if different from my current legal address and telephone numbers); g. My employer's or employers' name(s), dates of employment, and current locations; h. Vehicle registration information for vehicles I own or operate; and i. My signature on a summary of the criminal offenses 1) against victims who were minors and 2) sexually violent offenses, of which I have been convicted. 3. I understand that within three (3) working days of placement on probation, release from prison or confinement, release on furlough, parole, or arrival in a county where I plan to stay for more than ten (10) days, I must register in person with the county chief of police. 4. I understand that if I change my legal address I must inform the attorney general within three (3) working days. If the new address is in another state, I must register with the attorney general and county chief of police in that state within ten (10) days. 5. My lawyer has explained that if I do not register as required, or do not inform the attorney general of any change in my address, I may be subject to criminal charges. DATE DEFENDANT222S SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com