SEXUAL OFFENDER/SEXUAL PREDATOR REGISTRATION FORM AS) TOR E FOR USE BY LAW ENFORCEMENT AGENCIES Complete all sections, attach fingerprint card, photugraph, and genetic markers when available, and submit to the Department of Justice, GERS Building, 2" Floor, Virgin Islands. 00802 SECTION A ~ Status SECTION B - Contributing Agency Information (‘4 Sex Offender [ } Habitual Sexual Offender Agency Name { } Sex Predator Agency Address (Court Order Required) Phone Number: ( ) Fax: ( ) { | New Registration Checked for Warrants: { } Local System [ ] FCIC.NCIC SYSTEM [ | Modify Data CCH for Sex Offenses: [ ] Yes {}.No. yo, Bride 22 SECTION C ~ Registration Information ~~ Name: Ep ita) ine Eduaet Alias: pop: /-24 T3 Age: TS Lat |, Ks Middle MDY VI Driver's Licenseti Bes Exp. Date: j-2.0 -2ehs~ sore Race:_CJ SEX: HT: é WT Hair oy Eyes: Bt Scars, Marks, Tattoos: . ney: Linge. —. G OOOSL IY) SECTION D ~ Legal Residence rt Current Temporary Residence: Physical Address:_L. <. Games re Telephone: Ho Work: Address: A. Future Residence & Relationship:_® a> Telephone: SECTION E - Employment fe} Employed { } Unemployed Employer, FC Contact Person:_ Dawen Fos, &s Telephone Date of Employment:__}— #2 Address_§ 08 Rit this a SECTION F- Offense Information VICTIM [ } Adult 4 Minor [ ] Acquitted by Reason of Insanity Court/Court No. Ci Offense Committed Place of Conviction AG No, “fu Pres sg PwonumM Pp E AREPU! i SECTION G As a Sexual Offender or Sexual Predator (Title 14 V_LC. § 1721-1731) you are required by law to abide by the following: L Within five (5) working day of being placed under any type of supervision in the community you must use this form to register with the V.L Department of Justice. In the event you are moving to or returning to the USVI from another jurisdiction, you must register with the VI. Department of Justice within five (5) days of first residing in or returning to the USVI. . 2. In the event there is a change in your permanent or temporary residence after initial registration and any subsequent changes thereatter, you must notify the V1, Department of Justice within three (3) days after arrival at your new residence * 3 In the event there is a change in your address outside the USVI, you must register your new address with the VI. Department of Justice prior to departure and also register in your new jurisdiction within ten (10) days after establishing residence there if the new jurisdiction has a registration requirement. 4 You are required to verity your address with the V.L Department of Justice annually on the anniversary of your initial registration. If you were determined to be a sexually violent predator, you must verify your address with the V.f. Department of Justice every ninety (90) days after the date of your initial release or commencement of parole. 5. Failure to comply with the above requirements shall subject you to a fine of not less than $3,000.00 or imprisonment for not less than three (3) months or more than two (2) years, of both. Be Reminded that even if you may not be required to register under Virgin Islands Law, under Title | of the Adam Walsh Act entitled the "Sexual Offender Registration and Notification Act “(SORNA), all individuals convicted of a sex offense are required to register and keep their registration current in each jurisdiction where he or she resides, is an employee and Is a student. Registrant; [ acknowledge that the above requirements as set forth EFTA00309984