Form Sp 4-218 - Sexual Offender Registration (Page 12 of 12) in pdf

If you are a Sexually Violent Predator or a Sexually Violent Delinquent Child you are required to attend at least monthly

counseling sessions. If you have been designated a sexually violent predator (or similar designation) in another jurisdiction

and are required to undergo counseling, you are required to attend monthly counseling sessions in Pennsylvania. If you fail to

attend monthly counseling sessions you are subject to arrest and prosecution pursuant to 18 Pa.C.S. § 4915.1.

Your name, address, and other identifying factors will be disseminated to law enforcement agencies.

Certain other

information about you will be made available to the public on the Megan’s Law Website. If you have been designated as a

Sexually Violent Predator or a Sexually Violent Delinquent Child this information will also be disseminated to victim(s),

neighbors, schools, day care centers, colleges, county children and youth agencies, and to the general public upon request.

You should have been informed of your registration requirements by your sentencing court. NOTE: the terms of your

registration (including Tier and length of registration) are mandated by statute and are not part of your criminal sentence. If

the court failed to inform you of your registration requirements (or incorrectly informed you of the same) this does not relieve

you of your obligation to register as a sexual offender in accordance with the requirements of Megan’s Law.

It is your responsibility as a sex offender, to review and verify all information on this form and ensure it is correct. You should

immediately bring any errors to the attention of the registering official before leaving the registration site. A failure to provide

complete and accurate information when registering will subject you to arrest and felony prosecution pursuant to 18 Pa.C.S.

§ 4915.1.

Any questions regarding your registration requirements should be directed to the Pennsylvania State Police, Megan’s Law Section by

calling toll free 1-866-771-3170 or by writing the Pennsylvania State Police, Megan’s Law Section, 1800 Elmerton Avenue, Harrisburg,

PA 17110-9758.

I acknowledge that I have read and understand the requirements set forth in blocks 1 through 6. I verify the facts set forth in

this registration form are true and correct to the best of my knowledge, information and belief. This verification is made subject

to the penalties of 18 Pa.C.S. §§ 4904 and 4915.1 (relating to unsworn falsification to authorities, and failure to comply with

registration of sexual offenders requirements, respectively).

7. SIGNATURE - OFFENDER

8. DATE

I certify that I have read to the offender the requirements set forth above.

9. SIGNATURE - REGISTERING OFFICIAL

10. TITLE

11. DATE

12. PRINTED NAME –

13. DEPARTMENT/AGENCY/FACILITY & ORI

14. TELEPHONE NUMBER

REGISTERING OFFICIAL

(INCLUDE PSP STATION NAME)

(EXTENSION IF NECESSARY)

Ext.

Forward this form, with a current photograph(s) to:

Pennsylvania State Police

Bureau of Records and Identification

Megan’s Law Section

1800 Elmerton Avenue

Harrisburg, PA 17110-9758

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Form Sp 4-218 - Sexual Offender Registration Page 12