EFTA00315044.pdf

"1",1\ 1\I -\\D‘ Di PAR I Mi . \ i 1H II NIII I Ol i ! 7! 11 1()K \I) CIl \l t \I % 'Rol \ . -. \: ‘I t 'I I I \Di R RI (d.i bt‘, SEXUAL OFFENDER REGISTRATION FORM FOR USE BY LAW ENFORCEMENT AGENCIES PLEASE PRINT - COMPLETE ALL SECTIONS SECTION A- Tier/Status SECTION B SECTION B vi Tier ! [ ] New Registratior [ : :aro* [ ] Tier I, [ I Modify Data I 1 Praetor: [ j Tier III ()ft Rental Registratial [ I Supervised Release SECTION 0 - Registration Information Name: C. VS11.<4` ....)- 4klisciAlias:_______ .___.. SSW. Oir)- ti 1" Y id Alien #. /-1, -(V _ ar i ; no tkire . ...--„ DOB: I —14 et 3- P08: _ • VI Drivers License#:r I C* S V 1173„ i VZ.:71 -e Exp wit 1120117 V)! 700'. Race:_t, Sex. rA.f_ Ht.. Wt:._ Litt, Hair: _el__ Eyes_.IL/ Scars. Marks. Tattoos: SECTION E- Residence I I HOMELESS Closest Living Relative I I NIA a eft Physical Address: 1-.> '1"iewle.-, . Name. Aettoit Relationship rites , Mailing Address: I Q0 144 [t.izi_ J 4 i PS 2 Temporary Address: r. Contact #: Home: 7-)r-y Iv Cellular Lt cen _I -)* Contact ft Home: Cellular: `It I ) ‘513 -14 SECTION F - Internet Identifiers -List any and all email addresses used. Instant Messaging addresses and identifiers. designations or monikers in intemet communications and postings, and an social network identifiers [ ] N/A SECT ION G -_Erriploy7ent it •rlinPloYed [ ) Unemployed Employer. _ Alfie: _Slaallio idol co.) Contact Person._ . . . _... ._ Occupation. _gant‘se ___ Telephone_)j - 2J_ Z. r - Address: 12 Or J'e't P. Date Employment:.__ _ __ _ Employer: Contact Person.` __ ____ ____ , __ Occupation _ _ .. Telephone Address. Date Employment __ _ SECTION H - Volunteer Information Organization . . _Jil_i_iki _ _. _ _ Contact Person._ .. _ . Duties Telephone _. _ . Address. _ . . ______ ___ Organization Contact Person.___ _ ____. Duties Telephone: Address: SECTION I - Occupational License Information [ [WA see Q44 0C Mel Date. - . - , _ . _. _ ____ __ _ ___ Occupations License Issuer ______ ___ . SECTION J - Education Information [4 N/A Dates Enrolled: School: Address. SECTION K - Vehicle, Trailer, Vessel, Etc. [ ] NIA Se e 4-11-ac hg d Description (Year/Make/Model/Color Scheme) • License Plate#: VINt Permanent/Frequent Location of Vehicle. EFTA00315044 SECTION L - Offense Information VICTIM f 1 Adult [ ] Mror 1 Acquitted by Reason of Insanity Oa 91C n bon ifense Committed Victim a. ‘p Race Conviction of CourtiCourt No Au NC / L (tel./tin talon how Are You Registered as a Sex Offender in another State: [ ] NO [ ] YES If YES, which state: and at what LEVEL SECTION M - PLEASE READ CAREFULLY BEFORE SIGNING Asa Sexual Offencer te .zyiC § 172!•17311 you are required by Ian to abide by the following Within three (3) business days of moving to or returning to the Virgin Islands you must register in tne Virgin islands and keep your registration current in each jurisdiction in which you reside and in each jurisdiction where you are employed (inciuding self-employment non-compensated and volunteer activities). and in each jurisdiction where you are a student 2 In me event there is a change in your name. employment, residence, temporary lodging information, vehicle information, or internet identifiers you are required to appear in person at the Department of Justice not later than three (3) working days after such change. 3 In the event that you move outside of the United States Virgin Islands. you must register your new address vnth the Department of Justice before you leave and you must also register in your new state not later than three (3) business days after arrival there if your new state has a registration requirement. 4 In the event that you are traveling outside of the Virgin Islands your are to required to appear in person at the Department of Justice prior to your departure and provide your travel destination. dates of travel. places of arrival and departure. itinerary details address. contact telephone information. and purpose of travel 5 Depending on the type of sex offense for which you have been convicted you are required to appear in person at the Department of Justice to verify your information and to take a current photograph. when necessary. ( ] every three (3) months [ ]every six (6) months (pevery year. 6 Depending on the type of sex offense for which you have been convicted. you are required to appear in person at the Department of Justice to verify your information and to take a current photograph. when necessary. for a period of 74 15 years 1 25 years [ ] for life. ikire to comply with these obligations subjects you to prosecution for failure to register or update your registration pursuant to a. Virgin Islands Code, Title 14, Section 1730, punishable by a fine not less than $3,000 nor more than $5.000, or imprisonment for not less than three months nor more than two years, or both; and ... b. Federal Law. 18 U.S.C. Section 2250. punishable by up to 10 years of imprisonment. Be Reminded that under Title I of the Adam Walsh Act entitled the "Sexual Offender Registration and Notification Act ISORNA) all individuals convicted of a sex offense are required to register and keep their registration current in each jurisdiction where he or the resides, is an employee and is a student FAILURE TO DO SO MAY SUBJECT YOU TO CRIMINAL PROSECUTION YOUR NEXT REGISTRATION DATE: gare & cl op Registrant: Witness: I acknowl hat the above requirements as set forth have been I certify that cifically informed the offender of his /her duties as set expla forth abo e hs cleated to me an understanding cl those duties. Swaged Fteg &gnaw _3140112- Dat 1161 r. /I j IA(iqtta tct Print Nan Na EFTA00315045