Form JD-CR-122 "Application for Exemption From Sex Offender Registration Requirements" - Connecticut

What Is Form JD-CR-122?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2016;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-CR-122 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-CR-122 "Application for Exemption From Sex Offender Registration Requirements" - Connecticut

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APPLICATION FOR EXEMPTION
CONNECTICUT JUDICIAL BRANCH
FROM SEX OFFENDER
REGISTRATION REQUIREMENTS
SUPERIOR COURT
www.jud.ct.gov
JD-CR-122 Rev. 5-16
C.G.S. §§ 53a-71, 53a-73, 53a-189, 54-251
INSTRUCTIONS TO APPLICANT
INSTRUCTIONS TO CLERK
1. Complete this form with information for the case in which you were convicted
1. Do not accept this Application if the Applicant fails to also
or found not guilty by reason of mental disease or defect and for which you
submit a completed JD-VS-3, Notice of Application.
are asking for an exemption from the duty to register as a sex offender.
2. Get original court file and schedule application for hearing.
2. File the original and 1 copy with the clerk of court.
3. Give notice to prosecutor and applicant.
3. Forward a copy to the prosecuting attorney for the offense for which you are
4. If application is granted, send copy to Department of Public
seeking to be released from the obligation to register.
Safety and to the agency having custody of the offender (DOC
4. You must also complete and attach form JD-VS-3, Notice of Application.
if incarcerated, PSRB if committed, CSSD if probation), if any.
TO: The Superior Court of the State of Connecticut
FROM (Name of Applicant)
DATE OF BIRTH
DOCKET NO.
ADDRESS OF APPLICANT (Number, Street, Town, and Apt. No )
DATE SENTENCED
ADDRESS OF SENTENCING COURT (Number, street, and town)
COURT SENTENCED AT (J.D. or G.A )
I, the Applicant signing below, ask the court to exempt me from the sex offender registration requirements of section 54-251 of the
Connecticut General Statutes because:
1. I was convicted or found not guilty by reason of mental disease or defect of: (“X” one)
Sexual assault in the 2nd degree under section 53a-71(a)(1) of the Connecticut General Statutes (for engaging in sexual
intercourse with another person who was 13 or older but under 16 and I was more than three years older than that person) and I
was less than 19 years old at the time of the offense.
OR
Sexual assault in the 4th degree under section 53a-73a(a)(2) of the Connecticut General Statutes (for subjecting another person
to sexual contact without that person's consent).
OR
Voyeurism under section 53a-189a(a)(2) of the Connecticut General Statutes (for knowingly photographing, filming, videotaping,
or otherwise recording the image of another person (A) without that person's knowledge and consent; (B) while that person was
not in plain view; and (C) under circumstances where that person had a reasonable expectation of privacy, with the intent to
arouse or satisfy my sexual desire).
OR
Voyeurism under section 53a-189a(a)(3) of the Connecticut General Statutes (for committing simple trespass and observing
another person in other than a casual or cursory manner (A) without that person's knowledge or consent, and (B) while that person
was inside a dwelling and not in plain view, and (C) under circumstances where that person had a reasonable expectation of
privacy, with the intent to arouse or satisfy my sexual desire).
OR
Voyeurism under section 53a-189a(a)(4) of the Connecticut General Statutes (for knowingly photographing, filming, videotaping or
otherwise recording the genitals, pubic area, or buttocks of another person, (A) without that person's knowledge and consent, and
(B) while that person's genitals, pubic area, buttocks, undergarments, or stockings were not in plain view, with the intent to arouse
or satisfy my sexual desire, or to arouse or satisfy the sexual desire of any other person)
2. I was released into the community, on or after October 1, 1998 with respect to this offense.
3. Registration is not required for public safety because of the following reason(s) (specify):
4. I have notified the Office of Victim Services and the Victim Services Unit within the Department of Correction of this application. A
completed form JD-VS-3, Notice of Application, is attached to this application as proof of notice to the Office of Victim Services and to
the Victim Services Unit within the Department of Correction.
I have read the information above and
SIGNED (Applicant)
DATE SIGNED
X
understand it. I agree with these statements.
CONSENTED TO BY (Parent or Guardian)
SIGNED (Attorney for Applicant)
DATE SIGNED
ORDER OF COURT
The application is DENIED.
The Court, having found that registration is not required for public safety and, if the Applicant was convicted of a violation of
section 53a-71(a)(1) of the Connecticut General Statutes, that the Applicant was under the age of nineteen at the time of the
offense, GRANTS the application and the Applicant is exempted from the registration requirements of section 54-251 of the
Connecticut General Statutes.
SIGNED (Judge, Assistant Clerk)
DATE SIGNED
PRINT
RESET
APPLICATION FOR EXEMPTION
CONNECTICUT JUDICIAL BRANCH
FROM SEX OFFENDER
REGISTRATION REQUIREMENTS
SUPERIOR COURT
www.jud.ct.gov
JD-CR-122 Rev. 5-16
C.G.S. §§ 53a-71, 53a-73, 53a-189, 54-251
INSTRUCTIONS TO APPLICANT
INSTRUCTIONS TO CLERK
1. Complete this form with information for the case in which you were convicted
1. Do not accept this Application if the Applicant fails to also
or found not guilty by reason of mental disease or defect and for which you
submit a completed JD-VS-3, Notice of Application.
are asking for an exemption from the duty to register as a sex offender.
2. Get original court file and schedule application for hearing.
2. File the original and 1 copy with the clerk of court.
3. Give notice to prosecutor and applicant.
3. Forward a copy to the prosecuting attorney for the offense for which you are
4. If application is granted, send copy to Department of Public
seeking to be released from the obligation to register.
Safety and to the agency having custody of the offender (DOC
4. You must also complete and attach form JD-VS-3, Notice of Application.
if incarcerated, PSRB if committed, CSSD if probation), if any.
TO: The Superior Court of the State of Connecticut
FROM (Name of Applicant)
DATE OF BIRTH
DOCKET NO.
ADDRESS OF APPLICANT (Number, Street, Town, and Apt. No )
DATE SENTENCED
ADDRESS OF SENTENCING COURT (Number, street, and town)
COURT SENTENCED AT (J.D. or G.A )
I, the Applicant signing below, ask the court to exempt me from the sex offender registration requirements of section 54-251 of the
Connecticut General Statutes because:
1. I was convicted or found not guilty by reason of mental disease or defect of: (“X” one)
Sexual assault in the 2nd degree under section 53a-71(a)(1) of the Connecticut General Statutes (for engaging in sexual
intercourse with another person who was 13 or older but under 16 and I was more than three years older than that person) and I
was less than 19 years old at the time of the offense.
OR
Sexual assault in the 4th degree under section 53a-73a(a)(2) of the Connecticut General Statutes (for subjecting another person
to sexual contact without that person's consent).
OR
Voyeurism under section 53a-189a(a)(2) of the Connecticut General Statutes (for knowingly photographing, filming, videotaping,
or otherwise recording the image of another person (A) without that person's knowledge and consent; (B) while that person was
not in plain view; and (C) under circumstances where that person had a reasonable expectation of privacy, with the intent to
arouse or satisfy my sexual desire).
OR
Voyeurism under section 53a-189a(a)(3) of the Connecticut General Statutes (for committing simple trespass and observing
another person in other than a casual or cursory manner (A) without that person's knowledge or consent, and (B) while that person
was inside a dwelling and not in plain view, and (C) under circumstances where that person had a reasonable expectation of
privacy, with the intent to arouse or satisfy my sexual desire).
OR
Voyeurism under section 53a-189a(a)(4) of the Connecticut General Statutes (for knowingly photographing, filming, videotaping or
otherwise recording the genitals, pubic area, or buttocks of another person, (A) without that person's knowledge and consent, and
(B) while that person's genitals, pubic area, buttocks, undergarments, or stockings were not in plain view, with the intent to arouse
or satisfy my sexual desire, or to arouse or satisfy the sexual desire of any other person)
2. I was released into the community, on or after October 1, 1998 with respect to this offense.
3. Registration is not required for public safety because of the following reason(s) (specify):
4. I have notified the Office of Victim Services and the Victim Services Unit within the Department of Correction of this application. A
completed form JD-VS-3, Notice of Application, is attached to this application as proof of notice to the Office of Victim Services and to
the Victim Services Unit within the Department of Correction.
I have read the information above and
SIGNED (Applicant)
DATE SIGNED
X
understand it. I agree with these statements.
CONSENTED TO BY (Parent or Guardian)
SIGNED (Attorney for Applicant)
DATE SIGNED
ORDER OF COURT
The application is DENIED.
The Court, having found that registration is not required for public safety and, if the Applicant was convicted of a violation of
section 53a-71(a)(1) of the Connecticut General Statutes, that the Applicant was under the age of nineteen at the time of the
offense, GRANTS the application and the Applicant is exempted from the registration requirements of section 54-251 of the
Connecticut General Statutes.
SIGNED (Judge, Assistant Clerk)
DATE SIGNED
PRINT
RESET