(you agency) LAW ENFORCEMENT
SEX OFFENDER REGISTRATION NOTIFICATION
REQUIREMENTS OF THE LAW (your code). Offenders shall register with the (agency) Tribal law Enforcement Office in person and comply with the registration procedures. The following information shall be provided to law enforcement by the offender.
1. NAME
2. COMPLETE RESIDENTIAL ADDRESS (Actual physical and mailing)
3. PLACE OF EMPLOYMENT
4. CRIME FOR WHICH CONVICTED
5. DATE AND PLACE OF CONVICTION
6. ALIASES USED
7. SOCIAL SECURITY NUMBER
8. PHOTOGRAPH
9. FINGERPRINTS; AND
10. DNA
NOTE: Law Enforcement will ask for a physical description and the place of birth. This will be forwarded to the FBI Identification section.
If any person required to register changes his or her address within the external boundaries of the (Tribe) Reservation, the person must give signed written notice, in person to the (tribe name) Tribal Law Enforcement within 24 hours of moving. (initials)
Sex Offenders who move off the (tribe) Reservation to another, reservation, county, state or country are required to register with the appropriate law enforcement agency(s) in accordance to the laws of that jurisdiction. Offenders are also required to notify (your tribe) Tribal Law Enforcement within 24 hours of moving from the reservation. (initials)
OFFENDERS WHO LACK A FIX RESIDENCE. Any person required to register under this section shall provide notice to (your tribe) Tribal Law Enforcement within 24 hours after ceasing to have a fixed residence. The notice shall include:
1. Name
2. Last fixed address
3. Mailing address
4. Date and place of Birth
5. Aliases used
6. Place of Employment
7. Crime for which convicted
8. Date and place of conviction
9. Social Security Number
10. Description and location of intended place he/she plans to stay
11. Photograph and fingerprints
Any person who lacks a fixed residence and leaves the external boundaries of the reservation, and enters and remains in a new jurisdiction for 24 hours is required to register with the new county in 24 hours. (initials)
OFFENDERS WHO ARE NEW RESIDENTS OR RETURNING TO THE RESERVATION. Sex offenders and kidnapping offenders who move to the (your tribe) Reservation from another reservation, state or a foreign country are required to register with the (your tribe) Tribal Law Enforcement within 24 of establishing residence on the (your tribe) Reservation. NOTE: Only enrolled tribal members convicted of a sex or kidnapping offence may be permitted to live within the external boundaries of the (your tribe) Reservation. All other convicted sex or kidnapping offenders are excluded from the reservation and subject to arrest for criminal trespass. (initials)
OFFENDERS NAME CHANGES. A sex offender subject to registration requirements who applies to change his/her name shall submit a copy of the application to (your tribe) Tribal Law Enforcement not fewer than five days before entry of an order granting the name change. No sex offender under requirement to register under this section at the time of application shall be granted an order changing his/her name if the court finds that doing so will interfere with legitimate law enforcement interests, except that no order shall be denied when the name change is requested for religious or legitimate cultural reasons or in recognition of marriage or dissolution of marriage. A sex offender who receives an order changing his/her name shall submit a copy of the order to (your tribe) Tribal law Enforcement within five days of entry of the order. (initials)
PENALTIES IF YOU FAIL TO REGISTER. Any person who knowingly fails to register with (your tribe) Tribal Law Enforcement, or who changes his/her name without notifying (your tribe) Tribal Law Enforcement, as required by the subsection, is guilty of a Class C offense if the crime convicted was a felony sex offense or kidnapping as defined in subsection (h)(1) or (h)(2) of this subsection or a federal or out of state conviction for any offense that under the laws of this state would be a felony sex offence. If the crime was other than a felony or a federal or out of state conviction for an offense that under the laws of this state would be other than a felony, violation of this subsection is a Class D offense. (initials)
LENGTH OF REGISTRATION. HOW LONG YOU MUST REGISTER DEPENDS ON THE SEX OFFENSE FOR WHICH YOU WERE CONVICTED. (initials)
REMEMBER: IT IS A CRIME TO KNOWINGLY FAIL TO COMPLY WITH ANY OF THE REGISTRATION REQUIREMENTS OF (your code) UNLESS YOU ARE RELIEVED OF THE REGISTRATION REQUIREMENT AS DESCRIBED BY LAW. IT IS YOUR RESPOSIBILITY TO OBEY THE LAW AND REGISTER.
I, (NAME) ,(DOB) , HAVE READ OR HAVE HAD READ TO ME THE REGISTRATION NOTIFICATION REQUIRMENTS. I UNDERSTAND THEM, AND HEREBY AGREE TO COMPLY.
, , ,
OFFENDERS SIGNATURE DATE WITNESS