/ DEPARTMENT OF SOCIAL AND HEALTH SERVICES (DSHS)
DSHS Sex / Kidnapping
Offender Preregistration / FINGERPRINT CARD ATTACHED
TO: / COUNTY SHERIFF / (COUNTY OF RELEASE)
FROM: / (AGENCY OF RELEASE)
PHOTO

DSHS 09-746A (REV. 10/2016)

DSHS 09-746A (REV. 10/2016)

NAME / DATE OF RELEASE
ALIASES USED (IF ANY)
DSHS ID NUMBER / SOCIAL SECURITY NUMBER / DATE OF BIRTH / PLACE OF BIRTH
RELEASE ADDRESS
CRIME REQUIRING REGISTRATION / COUNTY / CAUSE NUMBER
DATE OF CONVICTION / PLACE OF CONVICTION
PLACE OF EMPLOYMENT (IF KNOWN)
Registering at the facility does not relieve offenders of the responsibility to register with the County Sheriff of residence within three business days of release.
FACILITY CONTACT PERSON’S NAME (PLEASE PRINT)
/ DATE / TELEPHONE NUMBER (INCLUDE AREA CODE)
Please note: Under RCW 9A.44.130, offenders with the following offenses must register with the county sheriff in the county of the offender’s residence:
Rape 1o, 2o, 3o (RCW 9A.44.040, 050 and 060, respectively)
Rape of Child 1o, 2o, 3o (RCW 9A.44.073, 076 and 079, respectively)
Child Molestation 1o, 2o, 3o (RCW 9A.44.083, 086 and 089, respectively)
Sexual Misconduct with a Minor 1o or 2o (RCW 9A.44.093 and 096, respectively)
Indecent Liberties (RCW 9A.44.100)
Sexually Violating Human Remains (RCW 9A.44.105)
Voyeurism (RCW 9A.44.115)
Custodial Sexual Misconduct (RCW 9A.44.160)
Criminal Trespass Against Children……………………………………………………………. (RCW 9A.44.(190), (193) & (196)
Incest 1o or 2 o (RCW 9A.64.020)
Kidnapping 1o or 2o (if victim is a minor and the offender is not the minor’s parent) (RCW 9A.40.020 and 030, respectively)
Unlawful Imprisonment (if victim is a minor and the offender is not the minor’s parent) (RCW 9A.40.040)
Sexual Exploitation of a Minor (RCW 9.68A.040)
Dealing in Depiction of a Minor Engaged in Sexually Explicit Conduct 1°, 2° (RCW 9.68A.050)
Sending or Bringing into State Depiction of Minor Engaged in Sexually Explicit Conduct 1°, 2°(RCW 9.68A.060)
Possession of Depictions of a Minor Engaged in Sexually Explicit Conduct 1°, 2° (RCW 9.68A.070)
Communication with a Minor for Immoral Purposes (RCW 9.68A.090)
Commercial Sexual Abuse of a Minor (RCW 9.68A.100)
Commercial Sexual Abuse of a Minor – Promote……………………………………………… (RCW 9.68A.101)
Travel for Commercial Sexual Abuse of a Minor – Promote…………………………………. (RCW 9.68A.102)
Any felony with a finding of sexual motivation (RCW 9.94A.835)
Any federal, military, foreign, or out of state conviction for an offense that would have been one of the foregoing offenses under the laws of the State of Washington
Any felony that, under RCW 9A.28, a criminal attempt, criminal solicitation, or criminal conspiracy to commit such crimes; or
A felony violation of RCW 9A.44.132 (1) (failure to register) if the person has been convicted of (failure to register) on at least one prior occasion;
A felony with a finding of sexual motivation under 9.94A.835 or 13.40.135.

DSHS 09-746A (REV. 10/2016)