Offender Instructions: - Alabama Law Enforcement Agency ...



right-3810CHECK ONE:( ) New Registration( ) Quarterly Registration( ) Yearly Registration( ) Address Change( ) Employment Change( ) School Change( ) Temporary Address( ) Homeless00CHECK ONE:( ) New Registration( ) Quarterly Registration( ) Yearly Registration( ) Address Change( ) Employment Change( ) School Change( ) Temporary Address( ) Homeless-13064461554Alabama Law Enforcement AgencySex Offender Registration00Alabama Law Enforcement AgencySex Offender Registration5081270-974090Form 47Revised Sept 201500Form 47Revised Sept 2015 164237337800 Offender InformationFull NameLastFirstMiddleSuffixSocial Security NumberBirth DatePlace of BirthBlood TypeAlternate SSN Alternate DOBHome/Cell Phone ( )Work Phone( )RaceSexHair ColorEye ColorHeightWeightSkin ToneAliases/Nicknames/Ethnic/Tribal NamesEmail AddressRegistrationStatus( ) Absconded ( ) Unknown( ) Compliant ( ) Non-compliantNearestRelativeNameRelationship Phone Number( )Offender’s AddressMailing Address Check if temporaryList Date Range:Street Address (if different) Apartment #Time at this residenceCityCountyStateZip CodeAre there any minors living at this address? (List names/age/relationship)Previous AddressStreetApartment #CityCountyStateZip CodeChecked for warrants Y N Outstanding warrants Y N FBI NumberSID NumberAIS NumberAny Cautions/Medical ConditionsScars/Marks/TattoosEmployment / School Information including day labor, volunteer, unpaid internship, etc.OccupationOffender’s Position or Job TitleIs this employment within 2,000 ft of a school or daycare? Y ? N ?EmployerName AddressWork Location (if different than employer address)SchoolSchool NameSchool Address ALEA Form 477/1/2019Other Identifying InformationDriver License/State ID numbers (include issuing State)Passport, Military ID, Immigration ID, Professional Licenses, etc.Professional Licenses (include type and number)Offense InformationOffense (include code section if known) (attach additional sheets if necessary)UCR CodeOffense DescriptionDate of ArrestState of CrimeCity of CrimeCourt Case #Disposition DateVictimAgeRace/SexRelationshipWeaponTypeMakeDescriptionCourt(Check one in each box)JurisdictionTypeStatusDNA Available Alabama conviction Out of State Military Federal Youthful Offender Juvenile Adult Probation Parole None Yes NoVehicle Information including land, aircraft and watercraft vehiclesSelect: Personal Work Other __________________TypeMakeModelStyle/ColorTag # / State YearVehicle Identification #Address vehicle is keptPlate CategoryPlate TypeYear ExpiresSelect: Personal Work Other __________________TypeMakeModelStyle/ColorTag # / StateYearVehicle Identification #Address vehicle is keptPlate CategoryPlate TypeYear ExpiresBy signing below, I affirm that all the information I have given is true and correct and is in compliance with the Alabama Sex Offender Registration and Community Notification Act. Failure to accurately complete and return this form could result in a felony conviction.Offender Signature Date Reporting Officer Signature Date Responsible AgencyReporting OfficerAgency Name AddressPhoneContact EmailAfter verifying the offender information for accuracy and completeness, enter your agency identifying information and email or mail this form along with a current photograph and fingerprints of the offender to:ALEA Sex Offender Registration UnitP O Box 1511Montgomery AL 36102-1511sexoffenderunit@ Main(334) 353-1172Fax(334) 353-2563 ................
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