Free Sex Offender Registration Form, CC 6:9 - Nebraska

STATE OF NEBRASKA FORM NO. CC 6:9 10/06 Rev.; Sec. 29-4007

CASE NUMBER

SEX OFFENDER REGISTRATION NOTICE

IN THE _______________ COURT OF ___________________ COUNTY, NEBRASKA

STATE OF NEBRASKA, Plaintiff vs.

NOTIFICATION OF REGISTRATION RESPONSIBILITIES UNDER NEBRASKA SEX OFFENDER REGISTRATION ACT

Defendant

NOTICE TO DEFENDANT:
Your conviction or guilty plea has caused you to be subject to the Nebraska Sex Offender Registration Act, Neb. Rev. Stat. §§ 29-4001 to 29-4013. If you are committed to the Department of Correctional Services for a conviction where the victim was a minor or a vulnerable adult, you shall attend appropriate sex offender treatment and counseling programming offered by the department. Refusal to participate in such programming shall not result in disciplinary action or a loss of good time credit for you, but it shall require you to undergo a civil commitment evaluation prior to the completion of your criminal sentence. According to the Nebraska Sex Offender Registration Act, you are required to register with the sheriff of the county in which you reside or are temporarily domiciled within five working days after you become subject to the Act. "Temporarily domiciled" means a place at which a person actually lives or stays on a temporary basis, for at least five working days, even though he or she may plan to return to his or her permanent address or to another temporary address. The date you become subject to the Act is no later than the date of your sentencing. Your fingerprints and photograph will be obtained by any registering entity in order to comply with the registration requirements. The Act also includes the requirement that you verify the registration information at least annually. If the court has determined you to be a sexually violent predator, you are required to verify the registration information on a quarterly basis; that is, once every three months. The registration and verification requirements under the Act are continuing ones, expiring no sooner than ten years after your discharge from supervised release, probation, parole, or incarceration, whichever occurs last. You are required to register for the rest of your life if (a) the court determines you to be a sexually violent predator, (b) you have previously been convicted of a registrable offense, (c) your offense is considered to be an "aggravated" one, meaning that it involved (i) penetration of someone who was less than twelve years of age or (ii) penetration through force or threat of serious violence upon someone twelve or more years of age, or (d) if you are required to register as a sex offender for the rest of your life under the laws of another state, territory, commonwealth, or other jurisdiction of the United States. An appeal of your conviction does not relieve you from the registration requirements. However, the registration and verification requirements do not apply while you are Continued on reverse...

incarcerated in a jail, a penal or correctional facility, or any other public or private institution. Nevertheless, if you are incarcerated for more than five days, you are required to give notice of the incarceration and your expected release date, if available, to the sheriff of the county in which you would reside or would be temporarily domiciled but for your incarceration. You are to give the sheriff this notice within five working days of your incarceration. Prior to any type of release from incarceration, you are to report your change of address to the sheriff of the county in which you are incarcerated and to the county sheriff of the county in which you reside or are temporarily domiciled. If you move to a new address, whether in or out-of-state, you are to provide written notification of your new address to the county sheriff of the county of your former address (even if you did not move out of the county). The notification must be given within five working days after your move. If you have moved to a different county within the state, you are also to report to the county sheriff in your new county of residence, register with that sheriff and give notice of your current address. This notice must be given within five working days after your move. You shall also notify the sheriff of any changes in employment, vocation, or school of attendance, in writing, within five working days after the change. If you have moved out of state, you must also comply with the registration requirements of that state. If you no longer have a residence or temporary domicile, you shall notify the county sheriff in which you are located, in writing, within five working days after such change in residence or temporary domicile. You shall update your registration, in writing, on a form approved by the sex offender registration and community notification division of the Nebraska State Patrol at least once every thirty calendar days during the time you remain without a residence or temporary domicile. If you reside, move, or are temporarily domiciled out of state, but are employed or carry on a vocation (with or without compensation), or attend school in this state, you must report to, and register with, the county sheriff of the county in which you are employed, carry on a vocation, or attend school. You must also notify the sheriff of any change in such employment, vocation, or attendance status at the school or postsecondary educational institution, in writing, within five working days of such change. If you attend, or are employed or carry on a vocation (with or without compensation) at a postsecondary educational institution, you must inform the sheriff of the county of your residence of this fact, including the identity of the educational institution. The notice to the sheriff must be in writing and must be given within five working days after becoming employed, carrying on a vocation, or attending the institution. You must also notify the sheriff of any change in such employment or attendance status at the postsecondary educational institution. You shall inform the sheriff of any legal change in name, in writing, within five working days after such change, and provide a copy of the legal documentation supporting the change in name. If, while residing or being temporarily domiciled in Nebraska, you go to another state to attend school or work, you must comply with the registration requirements of both states. Any person required to register under the Act who violates the Act has committed a Class IV felony unless the offense giving rise to the duty to register was a misdemeanor, in which case the violation of the Act carries the same penalty range as the offense which gave rise to the duty to register. Any person required to register under the Act, who violates the Act and who has previously been convicted of a violation of the Act is guilty of a Class III felony and shall be sentenced to a mandatory minimum term of at least one year in prison unless the act which caused the person to be placed on the registry was a misdemeanor, in which case the violation of the Act shall be a Class IV felony.

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The above is a summary of your registration and verification responsibilities under the Act. You should familiarize yourself with the Act and be alert to any amendments to it. Acknowledgment By my signature below, I acknowledge that I have read this Notification which explains my duty to register and I understand my obligations under the act. Defendant's Signature: ________________________________ __ Date: ___ /_ /_ _/_____ _/_____

Defendant's Name (print): ____________________________ Date of Birth: ___ Address:

(Street) _ __________________________, _______, _____________ (City) (State) (Zip Code) ( Y, N, Probation) ( Y, N, Incarceration)

__________________________________ JUDGE - CLERK OF COURT Date: ___ /_ _/______

(Original - Court) (Copy - Probation) (Copy & Journal Entry - County Attorney) (Copy & Journal Entry - Defendant) (Copy & Journal Entry - Sheriff of Defendant's Residence) (Copy & Journal Entry - State Patrol: Sex Offender Registry, PO Box 94907, Lincoln, NE, 68509)