If you would like the Public Defender’s Office to assist you with filing your petition for removal, or termination, from the sex offender registry pursuant to Penal Code § 290.5. please fill out this form by providing the information below.

First Name: required

Middle Name:

Last Name: required

Alias(es)/Maiden Name:

Date of Birth (MM/DD/YYYY): required

Where Were You Born? required

Information provided on this form is confidential, and protected by attorney-client privilege. This information will not be shared without your consent.

How would you prefer that our office contact you? required
MailEmailPhone

Do you authorize release of your information to the California Department of Justice for us to obtain a copy of your criminal history? required
YesNo

Mailing Address:

Address Line 1: required

Address Line 2:

City: required

State:
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code: required

Phone Number:

Email:

SSN: required

Driver's License:

CII (SID):

You must include your CII # on the application. CII is located on your Proof of Registration and your Tier Notification Letter — see below.

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ALTERNATE CONTACT PERSON

Optional. This will help us locate you in the future regarding post-conviction relief.

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WAIVERS AND AUTHORIZATIONS

If you understand and agree to the waivers and authorizations below, please place your initials in the space below each paragraph.

I UNDERSTAND AND WAIVE MY RIGHT:

to be present for all court proceedings related to the post-conviction process, provided that no new trial or retrial will occur. required

to be resentenced by any judge of the Superior Court, so long as the sentence is not greater than originally sentenced to. required

I AUTHORIZE THE SAN BERNARDINO COUNTY PUBLIC DEFENDER:

to petition on my behalf to the San Bernardino Superior Court for resentencing or redesignation pursuant to California state laws. required

to obtain any and all documents (including but not limited to all charging documents, discovery, motions, correspondence, notes, medical records and reports, investigative reports, and all other information written or otherwise recorded) contained in my criminal case file from any other jurisdiction to the Law Offices of the San Bernardino County Public Defender, and its representative, for purposes of determining my eligibility for post-conviction relief in any criminal case where San Bernardino County has jurisdiction. required

I authorize the San Bernardino County Public Defender to communicate with me about my case electronically by e-mail. required

I have read or have had this form read to me and have initialed each of the waivers and authorizations noted above. By placing my initials under each paragraph, I have indicated that I understand and agree to the rights, waivers, and authorizations set forth in each such paragraph.

Name required

Today’s Date (MM/DD/YYYY) required

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CURRENT PROOF OF REGISTRATION
We must have proof of your current registration to petition for removal from registry.
Are you currently registered? required
YesNo
County (include state if not CA):

Agency:

Do you have your proof of registration? required
YesNo
Date of Registration (MM/DD/YYYY):

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TIER NOTIFICATION LETTER (TNL)

This is a letter that you receive from your registering agency telling you which tier you are in. You should request your TNL from your agency ASAP.

Have you obtained your Tier Notification Letter? required
YesNo

DOJ Designated Tier: required
—Please choose an option—Tier 1 - AdultTier 2 - AdultTier 3 - AdultTier 1 - JuvenileTier 2 - JuvenileUnknown

Please attach copies of your proof of registration, tier notification letter, and Driver's License or State ID, or provide them as soon as possible.
Accepted file types: docx, jpg, jpeg, pdf, png. Maximum file size: 3 MB.

Other ways to submit your documents:
Email: Reply to the confirmation email you receive and attach the document(s).
Mail: Public Defender, Post-Conviction Unit, 323 W. Court St., San Bernardino, CA 92415
In person: Any San Bernardino Public Defender Office (click here for locations)

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MOST RECENT SEX CONVICTION

Complete as much information as possible.

PC§:

Crime:

County (include state if not CA):

Court Case Number:

Court:
AdultJuvenile

Arrest Date:

Conviction Date:

Sentence:

Release Date:

Total Sex Convictions:

Total Sex Cases:

Out of State (Fed/Military) Sex Offense?
YesNo

    Jurisdiction:

    Information:

Failure to Register Conviction(s)? required
YesNo

    Information:

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Have you been in custody since release from sex case? required
YesNo

If you have been arrested, please provide information below:

Date:

Court Case No.:

Charge(s):

Sentence:

County:

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HISTORY

Do any of the following apply to you?

Prior civil commitment? required
YesNo

    If yes, what type?
SVPMDSONGI for 290Other -- explain below

    Other:

Any open criminal case? required
YesNo

    If yes, charge:

    County:

Prior life sentence? required
YesNo

    Was life sentence for 667.61 or 667.71 one-strike sex crime?
YesNo

Currently in custody? required
YesNo

Currently on parole/probation/supervision? required
YesNo

    If in custody or on parole/probation/supervision:

    Court Case No.

    County:

    Booking/CDCR No.:

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Additional information we may need to process your application: