SOP_NUMBER: 222.08-att-1 TITLE: Georgia Sex Offender Registration Notification Form REFERENCE_CODE: IIG01-0001 DIVISION: Facilities TOPIC_AREA: 222 Policy-Court/Release/Transport/Transfer EFFECTIVE_DATE: 2011-04-01 WORD_COUNT: 3237 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/123074 URL: https://gps.press/sop-data/222.08-att-1/ SUMMARY: This form is used to collect and document required registration information from sex offenders in Georgia prior to their release from prison or placement on parole, probation, or supervised release. The form captures personal identification, offense details, employment information, residence details, and vehicle information as mandated by state law. GDC staff use this form to ensure sex offenders provide all required information before release and to facilitate their compliance with registration requirements with county sheriffs. KEY_TOPICS: sex offender registration, sex offender notification, offender information collection, release documentation, registration form, personal identification, residence information, employment information, vehicle information, OCGA 42-1-12, offender database ATTACHMENTS: 1. Georgia Sex Offender Registration Notification Form URL: https://gps.press/sop-data/222.08-att-1/ 2. Certification of Sex Offender Registration (Probation) URL: https://gps.press/sop-data/222.08-att-2/ 3. GCIC Operations Bulletin #98-07 - Capture and Transmission of Facial Images URL: https://gps.press/sop-data/222.08-att-3/ 4. Registration Reference Guide (IIG01-0001 Attachment 4) URL: https://gps.press/sop-data/222.08-att-4/ ======================================================================== FULL TEXT: ======================================================================== IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form _*Asterisk denotes required fields (if applicable)_ **Offender Information** |* Last Name * First Name * Middle Name|Col2|Col3|Col4|Col5|Col6|Col7|Col8|Col9|Col10|Probation|Col12|*Fingerprints|Col14|DNA|Col16|*Photograph| |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| |||||||||||Yes
No|Yes
No|Yes
No|Yes
No|Yes
No|Yes
No|Yes
No| |*Date of
Birth|Place of
Birth|Place of
Birth|*Age|*Age|*Sex|*Race|*Race|*Height|*Weight|*Weight|*Hair Color|*Hair Color|*Eye Color|*Eye Color|*Social Security Number|*Social Security Number| |||||||||||||||||| |Driver’s License
Number|Driver’s License
Number|Driver’s
License
State|Driver’s
License
State|*Vehicle Make|*Vehicle Make|*Vehicle Make|*Vehicle Model|*Vehicle Model|*Vehicle Model|*Vehicle Model|*Vehicle Color|*Vehicle Color|*Vehicle
Year|*Vehicle
Year|
*Vehicle Tag Number|
*Vehicle Tag Number| |
|
|||||||||||||||| **Offender’s Additional Information** Name(s) Scars/ Marks/ Tattoos Date of Birth (s) Social Security Number(s) Vehicle Make Vehicle Model Vehicle Color Vehicle Year Vehicle Tag Number **Offense Information** *Crime(s) 1 _Revised July 2010_ IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form |Col1|Col2|Col3|Col4|Col5|Col6|Col7|Col8|Col9|Col10|Col11| |---|---|---|---|---|---|---|---|---|---|---| |*Date of
Offense|Date of
Arrest|*Prison Release Date|*Prison Release Date|*Probation
Start Date|*Parole Start
Date|*Parole Start
Date|SID Number|SID Number|FBI Number|GDC ID Number| |||||||||||| |*Date of
Conviction|Court of
Conviction|Court of
Conviction|Case Number|Sex of Victim|Sex of Victim|Age of Victim|Age of Victim|County of Conviction|County of Conviction|*State of
Conviction| |||||||||||| **Place of Employment** |*Name of Employer|*Address|*County|*City|*State|*Zip
Code|*Date of
Employment| |---|---|---|---|---|---|---| |||||||| **Institute of Higher Learning** |*Name of Institution|*Address|*County|*City|*State|*Zip Code| |---|---|---|---|---|---| ||||||| **Permanent Place of Residence or Homelessness** |*Complete Street Address or Location Where You Sleep
(if Homeless) or Prison Address Prior to Release|*County|*City|*State|*Zip Code| |---|---|---|---|---| |||||| |Complete Mailing Address or P.O. Box|County|City|State|Zip Code| |||||| **Temporary Place of Residence (If applicable)** |Complete Street Address|County|City|State|Zip Code| |---|---|---|---|---| |||||| |Complete Mailing Address or P.O. Box|County|City|State|Zip Code| |||||| **Place of Residence (Complete only if no permanent address provided)** | Motor Vehicle or Trailer| Mobile or Manufactured Home| Vessel, Live-Aboard Vessel
or Houseboat|Col4| |---|---|---|---| |Vehicle Identification Number|Mobile Home Location Permit Number|Hull Identification|Manufacturer’s Serial| _Revised July 2010_ 2 IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form |Col1|Col2|Number|Number| |---|---|---|---| ||||| |License Tag Number|Mobile or Manufactured Home
Owner Name and Address|Name of Vessel or
Houseboat|Registration Number| ||

||| |Description of Motor Vehicle or Trailer
(Including Make, Model, Color Scheme)|Description of Mobile or Manufactured Home
(Including Make, Model, Color Scheme and Where
Home is Located on Property)|Description of Vessel, Live-Aboard Vessel
or Houseboat
(Including Make, Model, Color Scheme)|Description of Vessel, Live-Aboard Vessel
or Houseboat
(Including Make, Model, Color Scheme)| ||||| **REGISTRATION INFORMATION FOR ALL SEX OFFENDERS** Pursuant to O.C.G.A § 42-1-12(a) (16), “Required registration information” means: (A) Name; social security number; age; race; sex; date of birth; height; weight; hair color; eye color; fingerprints; and photograph; (B) Address within this state or out of state, and, if applicable in addition to the address, a rural route address and a post office box; (C) If the place of residence is a motor vehicle or trailer, the vehicle identification number, the license tag number, and a description, including color scheme, of the motor vehicle or trailer; (D) If the place of residence is a mobile home, the mobile home location permit number; the name and address of the owner of the home; a description, including the color scheme of the mobile home; and, if applicable, a description of where the mobile home is located on the property; (E) If the place of residence is a manufactured home, the name and address of the owner of the home; a description, including the color scheme of the manufactured home; and, if applicable, a description of where the manufactured home is located on the property; (F) If the place of residence is a vessel, live-aboard vessel, or houseboat, the hull identification number; the manufacturer's serial number; the name of the vessel, live-aboard vessel, or houseboat; the registration number; and a description, including color scheme, of the vessel, live-aboard vessel, or houseboat; (F.1) If the place of residence is the status of homelessness, information as provided under paragraph (2.1) of subsection (f) of this Code section; (G) Date of employment, place of any employment, and address of employer; (H) Place of vocation and address of the place of vocation; (I) Vehicle make, model, color, and license tag number; (J) If enrolled, employed, or carrying on a vocation at an institution of higher education in this state, the name, address, and county of each institution, including each campus attended, and enrollment or employment status; and (K) The name of the crime or crimes for which the sexual offender is registering and the date released from prison or placed on probation, parole, or supervised release. Pursuant to O.C.G.A § 42-1-12(f), Any sexual offender required to register under this Code section shall: (1) Provide the required registration information to the appropriate official before being released from prison or placed on parole, supervised release, or probation; (2) Register in person with the sheriff of the county in which the sexual offender resides within 72 hours after the sexual offender's release from prison or placement on parole, supervised release, probation, or entry into this state; (2.1) In the case of a sexual offender whose place of residence is the status of homelessness, in lieu of the requirements of paragraph (2) of this subsection, register in person with the sheriff of the county in which the sexual offender sleeps within 72 hours after the sexual offender's release from prison or placement on parole, supervised release, probation, or entry into this state and provide the location where he or she sleeps; (3) Maintain the required registration information with the sheriff of each county in which the sexual offender resides or sleeps; _Revised July 2010_ 3 IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form (4) Renew the required registration information with the sheriff of the county in which the sexual offender resides or sleeps by reporting in person to the sheriff within 72 hours prior to such offender's birthday each year to be photographed and fingerprinted; (5) Update the required registration information with the sheriff of the county in which the sexual offender resides within 72 hours of any change to the required registration information, other than where he or she resides or sleeps if such person is homeless. If the information is the sexual offender's new address, the sexual offender shall give the information regarding the sexual offender's new address to the sheriff of the county in which the sexual offender last registered within 72 hours prior to any change of address and to the sheriff of the county to which the sexual offender is moving within 72 hours prior to establishing such new address. If the sexual offender is homeless and the information is the sexual offender's new sleeping location, within 72 hours of changing sleeping locations, the sexual offender shall give the information regarding the sexual offender's new sleeping location to the sheriff of the county in which the sexual offender last registered, and if the county has changed, to the sheriff of the county to which the sexual offender has moved; and (6) Continue to comply with the registration requirements of this Code section for the entire life of the sexual offender, excluding ensuing periods of incarceration. _Revised July 2010_ 4 IIG01-0001 Attachment 1 4/01/2011 |Initial|Provision|Col3| |---|---|---| ||A.|According to the provisions of O.C.G.A § 42-1-12, you are hereby notified that you must register in person
as a sex offender in the State of Georgia for life unless relieved of that requirement by a court of competent
jurisdiction.
| ||B.|To comply with your initial registration requirements, you must report within 72 hours of your release from
prison, placement on probation, parole or supervised release or entry into the State of Georgia to the
appropriate Sheriff’s Office of the county where you reside.
| ||C.|If you are released from prison**for another offense**during the time that you are required to register**for a**
**sex offense,**then you must notify the Sheriff of the county where you last registered within 72 hours after
such release.
| ||D.|You must provide street or route address for your place of residence. A post office box does not constitute
an address. If you are homeless, you must provide a description of the place you sleep.
| ||E.|If the place of residence is a motor vehicle or trailer, provide the vehicle identification number, the license
tag number, and a description, including color/ color scheme, of the motor vehicle or trailer, and where the
motor vehicle or trailer is located.
| ||F.|If the place of residence is a mobile home, provide the mobile home location permit number, the name and
address of the owner of the home, a description including the color scheme of the mobile home and if
applicable, a description of where the mobile home is located on the property.
| ||G.|If the place of residence is a manufactured home, provide the name and address of the owner of the home, a
description including the color scheme of the manufactured home, and if applicable, a description of where
the manufactured home is located on the property.
| ||H.|If the place of residence is a vessel, live-aboard vessel, or houseboat, provide the hull identification number,
the manufacturer’s serial number, the name of the vessel, live –aboard vessel, or houseboat, the registration
number, and a description including color scheme of the vessel, or houseboat.
| ||I.|You must register all addresses.
| ||J.|You are required to register with the sheriff’s office of the county where you reside within 72 hours prior to
your birthday each year to be photographed and fingerprinted.
| ||K.|If you have been determined to be a**sexually dangerous** **predator**, you will remain on the registry for
life and you must register with the sheriff of the county of residence 72 hours prior to your birthday each
year and 6 months following your birthday to update your registration information.
| ||L.
|You shall not intentionally photograph a minor without the consent of the minor’s parent or guardian.
| ||M.
|If you have been determined to be a** sexually dangerous predator,** you will be required to wear an
electronic monitoring system for the remainder of your life as well_as pay for the monitoring fee._
| ||N.
|If you are enrolled, employed or practice a vocation at an institution of higher education in this state, you
must provide the name, address, and county of each institution including each campus attended and your
position or enrollment status, as well as any change in enrollment, employment, or vocation status to the
sheriff.
| ||O.
|If you are homeless, you must register in person to the sheriff of the county where you sleep within 72 hours
after release from prison or placement on parole, supervised release probation or entry into this state and
provide the location where you are sleeping.
| |
|
P.
|

If you are homeless, you must report in person to the sheriff of the county where you sleep within 72 hours
of changing your sleeping location.
| IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form |Initial|Provision|Col3| |---|---|---| |

|Q.
|If you are homeless, you must report in person to the sheriff of the county where you are registered
within 72 hours of changing your sleeping location, and to the sheriff of the county where you moved
your sleeping location within 72 hours of moving.
| ||R.
|If you change any of the required registration information, other than residence address, you must give
the new information to the sheriff of the county with whom you are registeredwithin 72 hours of the
change of information.
| ||S.
|Regardless if your new residence address is within your county or outside your county (even temporary),
you must give the new address to the sheriff of the county with whom you last registeredwithin 72 hours
prior to moving and to the sheriff of the county to which you are moving 72 hours prior to moving.
| ||T.
|You must register in any state where you are employed, volunteer, practice a vocation, or are a student.
| ||U.
|If you move to another state, you are required to report to the sheriff’s office you last registered with in
the State of Georgia within 72 hours prior to moving and to the designated law enforcement agency in
your new state of residence within 72 hours.
| ||V.
|You are subject to all registration requirements if you move to Georgia from any other place and are
required to register as a sex offender in another jurisdiction.
| ||W.
|Persons who are sentenced under the first offender act are subject to the registration requirements until
the offender successfully completes the requirements as set forth by the court.
| ||X.
|At this time, the laws concerning registration of sex offenders can be found in the Official Code of
Georgia Annotated, Section 42-1-12 through 42-1-19.
| ||Y.|You must meet certain criteria to petition the court for release from registration and/or
residency/employment restrictions. See O.C.G.A. § 42-1-19.
| |**Residency / Employment / Loitering Restrictions**|**Residency / Employment / Loitering Restrictions**|**Residency / Employment / Loitering Restrictions**| ||Z.
|If your date of offense was committed**prior to June 4, 2003**, there are no residency or employment
restrictions, however, you must adhere to all registration requirements. {O.C.G.A. § 42-1-17}| ||AA.
|If your date of offense was committed between**June 4, 2003 – June 30, 2006,**you cannot reside within
1,000 feet of any child care facility, school, or areas where minors congregate (public & private parks,
recreation facilities, playgrounds, skating rinks, neighborhood centers, gymnasiums, and similar facilities
providing programs or services directed towards persons under 18 years of age). {O.C.G.A. § 42-1-17}
| ||BB.
|If your date of offense was committed between** July 1, 2006 – June 30, 2008,**you cannot reside within
1,000 feet of any child care facility, church, school, areas where minors congregate (public & private
parks, recreation facilities, playgrounds, skating rinks, neighborhood centers, gymnasium, school bus
stops, and public & community swimming pools). {O.C.G.A. § 42-1-16}
| ||CC.
|If your date of offense was committed between** July 1, 2006 – June 30, 2008,**you cannot be employed
at any child care facility, church, school, or any business or entity that is located within 1,000 feet of said
location. {O.C.G.A. § 42-1-16}
| ||DD.
|If your date of offense was committed between** July 1, 2006 – June 30, 2008,**and you are a sexually
dangerous predator, you cannot be employed at any child care facility, church, school, area where minors
congregate (public & private parks, recreation facilities, playgrounds, skating rinks, neighborhood
centers, gymnasium, school bus stops, and public & community swimming pools) or any business or
entity that is located within 1,000 feet of said location. {O.C.G.A. § 42-1-16}
| ||EE.
|If your date of offense was committed between**July 1, 2006 – June 30, 2008,**you cannot loiter at any
child care facility, school, or areas where minors congregate (public & private parks, recreation facilities,
playgrounds, skating rinks, neighborhood centers, gymnasium, school bus stops, and public &
community swimming pools). {O.C.G.A. § 42-1-16}| ||FF.|If your date of offense was committed on** July 1, 2008 or after,**you cannot reside within 1,000 feet of| _Revised July 2010_ 6 IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form |Initial|Provision|Col3| |---|---|---| ||GG.
|If your date of offense was committed on** July 1, 2008 or after,**you cannot be employed/volunteer at
any child care facility, church, school, or any business or entity that is located within 1,000 feet of said
location. {O.C.G.A. § 42-1-15} A volunteer is defined at O.C.G.A § 42-1-15 (a) (4).
| ||HH.
|If your date of offense was committed on** July 1, 2008 or after,**and you are a sexually dangerous
predator, you cannot be employed/volunteer at any child care facility, church, school, area where minors
congregate (public & private parks, recreation facilities, playgrounds, skating rinks, neighborhood
centers, gymnasium, school bus stops, public libraries, and public & community swimming pools) or any
business or entity that is located within 1,000 feet of said location. {O.C.G.A. § 42-1-15}
| ||II.
|If your date of offense was committed on** July 1, 2008 or after,**loitering is prohibited at any child care
facility, school, or areas where minors congregate (public & private parks, recreation facilities,
playgrounds, skating rinks, neighborhood centers, gymnasium, school bus stops, public libraries, and
public & community swimming pools). {O.C.G.A. § 42-1-15}
| |**Additional Information**|**Additional Information**|**Additional Information**| ||JJ.|If you violate a sex offender statute, you may be found guilty of a felony and may be punished by
imprisonment for up to 30 years.
| ||KK.
|The current laws concerning sex offender registration can be found on the Georgia Secretary of State’s
website (www.legis.state.ga.us), the District Attorney’s Office, and many other places.
| ||LL.
|The Georgia legislature meets at least once each year, usually beginning in January, and each time the
legislature meets the laws concerning sex offender registration in Georgia can be changed. Most of those
changes take effect July 1; however, some changes take effect as soon as the legislation is signed by the
Governor.
| ||MM.
|It is_my duty_ to always be aware of the current law concerning my duty to register as a sex offender and I
understand that ignorance of the law is no excuse for my failure to abide by the laws concerning the
registration of sex offenders.
| ||NN.
|Every state in the United States has a sex offender registry; however, each state’s laws are different and
should I ever leave the State of Georgia, it is my duty to familiarize myself with the laws of the state
where I live. Ignorance of the law is no excuse for my failure to abide by the laws concerning the
registration of sex offenders in any state where I live.
| ||OO.
|If you are arrested on any charges, you must report in person to the sheriff’s office which you were last
registered immediately upon release to update your registration.
| ||PP.
|Under the Adam Walsh Child Protection and Safety Act of 2006, 18 United States Code § 2250, if you
fail to comply with registration requirements and are involved in interstate travel, you may be subject to
federal prosecution.| **I have read, or had read to me, this registration notification form and understand its contents.** ____________________________________ ___________________________________ Offender’s Name (Print) Offender’s Signature ____________________________________ ___________________________________ Witness Name (Print) Witness Signature _____________________________________ ___________________________________ Name of Witnessing Agency (Print) Telephone Number for Witnessing Agency _**The purpose of this form is to provide the necessary information for the registration of sexual offenders in the**_ _**State of Georgia. The information contained within this form is not intended to provide legal advice to any person**_ _**required to register as a sexual offender.**_ _Revised July 2010_ 7 IIG01-0001 Attachment 1 4/01/2011 # Georgia Sex Offender Registration Notification Form THE PENALTY O.C.G.A. § 42-1-12 **(n) Any individual who:** **(1)** **Is required to register under this Code section and who fails to comply with the** **requirements of this Code section;** **(2)** **Provides false information; or** **(3)** **Fails to respond directly to the sheriff of the county where he or she resides or sleeps** **within 72 hours prior to such individual’s birthday shall be guilty of a felony and** **shall be punished by imprisonment for not less than one nor more than 30 years;** **provided, however, that upon the conviction of the second offense under this** **subsection, the defendant shall be punished by imprisonment for not less than** **five nor more than 30 years.** **I have read, or had read to me, this registration notification form and understand its contents.** __________________________________ ___________________________________ Date Offender’s Name (Print) ___________________________________ ____________________________________ Offender’s Signature Offender’s Date of Birth ___________________________________ ___________________________________ Witness Name (Print) Witness Signature ___________________________________ ___________________________________ Name of Witnessing Agency (Print) Telephone Number for Witnessing Agency _Revised July 2010_ 7