Request For Publicly Accessible Massachusetts Cori
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1REQUEST FOR PUBLICLY ACCESSIBLE MASSACHUSETTS CORI
It is lawful to request this agency to provide a copy of another person’s publicly
accessible adult conviction record. For the adult conviction record to be “publicly
accessible” the person whose record is requested must have been convicted
of a crime punishable by a sentence of five years or more, or has been convicted of any
crime and sentenced to any term of imprisonment, and at the time of the request:
1.
is serving a sentence of probation or incarceration, or is under the custody of the
parole board; or
2.
having been convicted of a misdemeanor, has been released from all custody or
supervision not more than one year; or
3.
having been convicted felony, has been released from all custody or supervision
for not more than two years; or
4.
having been sentenced to the custody of the department of correction, has finally
been discharged therefrom, either having been denied release on parole or having
been returned to penal custody for violating parole for not more than three years.
Directions: Please fill this request form out as completely as possible. The more
information you are able to provide, the more easily this agency will be able to process
your request. A non-refundable processing fee of $30.00 is charged for each record
requested and must be included with your request(s). There will be no exceptions made
to this rule. Only checks or money orders made payable to the Commonwealth of
Massachusetts will be accepted. A self-addressed, stamped envelope must also be
enclosed with your request(s). Walk in requests or faxed requests will not be accepted.
Requests will be processed in the order in which they are received. Mail all requests to:
the Department of Criminal Justice Information Services, 200 Arlington Street, Suite
2200, Chelsea, MA 02150, ATTN: CORI Unit.
All requests must be typed. Requests containing any illegible identifying information will
be returned. If you are making more than one request, please copy this form and fill in the
requested identifying information accordingly.
1.
______________________ ______________________ ____________
Last name
First name
Middle initial
______________________
______________________ ________________
Maiden name
Alias
ID Index Number
(if applicable, not required)
______________________ ___________________
Date of Birth (MM/DD/YY) Social Security Number
(requested but not required)
2.
______________________ ______________________ ____________
Last name
First name
Middle initial
______________________ ______________________ _________________
Maiden name
Alias
ID Index Number
(if applicable, not required)
______________________ _____________________
Date of Birth (MM/DD/YY) Social Security Number
(requested but not required)
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