Free APPLICATION FOR EXEMPTION FROM SEX OFFENDER REGISTRATION REQUIREMENTS - Connecticut

APPLICATION FOR EXEMPTION FROM SEX OFFENDER REGISTRATION REQUIREMENTS
JD-CR-122 Rev. 10-06 C.G.S. §§54-251, 54-258, P.A. 06-187 §§35, 42

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 you are seeking to be released from the obligation to register. 3. Complete the form below with information for the case in which you were convicted or found not guilty by reason of mental disease or defect and for which you are seeking an exemption from the duty to register. 4. You must complete and attach form JD-VS-3, Notice of Application.

TO: The Superior Court of the State of Connecticut
FROM (Name of Applicant) ADDRESS OF APPLICANT (Number, Street, Town and Apt. No ) DATE SENTENCED COURT SENTENCED AT (J.D. or G.A ) ADDRESS OF SENTENCING COURT (Number, street and town) DATE OF BIRTH DOCKET NO.

I, the undersigned Applicant, hereby request the court to exempt me from the registration requirements of Connecticut General Statutes §54-251 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) and I was under the age of nineteen years at the time of the offense. OR 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). OR Connecticut General Statute §53a-189a(a)(2) (Voyeurism - when, with intent to arouse or satisfy the sexual desire of such person or any other person, such person knowingly photographs, films, videotapes or otherwise records the image of another person (A) without the knowledge and consent of such person, (B) while such person is not in plain view, and (C) under circumstances where such other person has a reasonable expectation of privacy.). 2. I was released into the community, as that term is defined in Connecticut General Statute §54-250(10), on or after October 1, 1998 with respect to the above violation. 3. Registration is not required for public safety for the following reason(s) (specify):

4. I have notified the Office of Victim Services and the Victim Services Unit within 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 Victim Services Unit within 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)

ORDER OF COURT The foregoing application is DENIED. The Court, having found that registration is not required for public safety and, if the Applicant was convicted of a violation of Connecticut General Statute §53a-71(a)(1), that the Applicant was under the age of nineteen at the time of the offense, hereby GRANTS the foregoing application and the Applicant is hereby exempted from the registration requirements of Connecticut General Statute §54-251.
SIGNED (Judge, Assistant Clerk) DATE SIGNED

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