PC 290 Relief Application For more information, see PC 290 Overview. First Name: required Middle Name: Last Name: required Alias(es)/Maiden Name: Date of Birth (MM/DD/YYYY): 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. * * * ALTERNATE CONTACT PERSON Optional. This will help us locate you in the future regarding post-conviction relief. First and Last Name: Relationship to You: Address Line 1: Address Line 2: City: State: —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Phone Number: Email: * * * 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): * * * 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 and/or TNL below, 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: Post-Conviction Unit Office, 900 E. Gilbert St., Bldg. 7, San Bernardino, CA 92415 In person: Any San Bernardino Public Defender Office (click here for locations) * * * 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: * * * 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: + add cases 2. Date Court Case No. Charge(s) Sentence County 3. Date Court Case No. Charge(s) Sentence County 4. Date Court Case No. Charge(s) Sentence County 5. Date Court Case No. Charge(s) Sentence County 6. Date Court Case No. Charge(s) Sentence County * * * 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.: * * * Additional information we may need to process your application: Please wait until a confirmation message appears. Return to PC 290 Overview