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J. SCOTT KEY LLC
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Sex offender registry removal form
IMPORTANT: You must complete the form as required and click SUBMIT at the bottom of the page for it to be sent.
potential client information
*
Indicates required field
Potential Client Name
*
First
Last
Age
*
Email
*
Potential Client's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Is Potential Client married?
*
Yes
No
Divorced
Does Potential Client have children?
*
Yes
No
Is potential client currently employed? If so, where?
*
on behalf of client
If not potential client, your name?
*
First
Last
[object Object]
Phone Number
*
Email
*
Your Relationship to Potential Client
*
Spouse
Parent
Sibling
Friend
Other
I'm the Potential Client
conviction information
Conviction Date
*
What was the sentence?
*
e.g. 20 years to serve, 5 years probation.
Date Sentence is to be completed?
*
Is client on?
*
Probation
Parole
Completed Parole
Completed Probation
No
Describe any issues while on probation or parole? If None, type NO ISSUES
*
Did potential client take a polygraph examination?
*
Yes
No
Don't Know
Has Client completed sex offender treatment?
*
Yes
No
Scheduled
If Yes or Scheduled, enter name and contact information of sex treatment provider
*
case details
Provide a brief summary of the facts of the conviction?
*
Did potential client properly register with sex offender registry?
*
Yes
No
I don't know
If potential client did not register, briefly explain why?
*
Has the Sex Offender Registry Board leveled the client?
*
Yes
No
I don't know
If Yes, when?
*
What was the classification level?
*
Level 1
Level 2
Sexually Dangerous Predator (SDP)
I was not leveled
Provide any additional details we should know?
*
referral information
How did you find us?
*
Attorney Referral
Internet Search
Friend/Family
Previous Client Referral
Other
Name of Attorney or person referring
*
Contact information if known
*
Submitting this form is for intake review purposes only and does not constitute an attorney client relationship.
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