Form Sp 4-218 - Sexual Offender Registration Page 9

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104. MUNICIPALITY (City/Township/Borough)
105. COUNTRY
106. GENERAL WORK AREA
107. START DATE
108. END DATE
/
/
/
/
109. RESPONSIBLE AGENCY HAVING JURISDICTION
EMPLOYER 2
110. EMPLOYER
112. SUPERVISOR’S NAME
111. OCCUPATION
113. TELEPHONE NUMBER
-
-
114. STREET ADDRESS 1
115. STREET ADDRESS 2
116. CITY
117. STATE
118. ZIP CODE
119. COUNTY
120. MUNICIPALITY (City/Township/Borough)
121. COUNTRY
122. GENERAL WORK AREA
123. START DATE
124. END DATE
/
/
/
/
125. RESPONSIBLE AGENCY HAVING JURISDICTION
SECTION J - VEHICLE INFORMATION
IF ADDITIONAL SPACE IS REQUIRED FOR MORE THAN 2 VEHICLES OPERATED OR OWNED, LIST ON SEPARATE PAGE
VEHICLE 1
126. VEHICLE TYPE
127. YEAR
128. MAKE
129. VEHICLE PRIMARY
Aircraft
Motorcycle
COLOR
Auto
Trailer
Boat
Truck
130. MODEL
131. STYLE
132. VEHICLE SECONDARY
COLOR
133. VEHICLE OWNERSHIP
134. VEHICLE IDENTIFICATION NUMBER
Loaner
Registered to Member of Household
(VIN)
Other
Registered to Relative That Does not Share Residence
Personal
Rental
135. IS THIS VEHICLE REGISTERED?
Registered to Acquaintance
Work
YES
NO
136. PLATE #
137. STATE
138. IS LICENSE PLATE
PLATE EXPIRATION DATE
139. LICENSE PLATE TYPE
EXPIRATION DATE NON-
EXPIRING?
/
/
YES
NO
140. ADDITIONAL DETAILS
141. GENERAL PARKING LOCATIONS
VEHICLE 2
142. VEHICLE TYPE
143. YEAR
144. MODEL
145. VEHICLE PRIMARY COLOR
Aircraft
Motorcycle
Auto
Trailer
146. MAKE
147. STYLE
148. VEHICLE SECONDARY
Boat
Truck
COLOR
149. VEHICLE OWNERSHIP
150. VEHICLE IDENTIFICATION NUMBER
Loaner
Registered to Member of Household
(VIN)
Other
Registered to Relative That Does not Share Residence
Personal
Rental
151. IS THIS VEHICLE REGISTERED?
Registered to Acquaintance
Work
YES
NO
152. PLATE #
153. STATE
154. IS LICENSE PLATE
PLATE EXPIRATION DATE
155. LICENSE PLATE TYPE
EXPIRATION DATE NON-
EXPIRING?
/
/
YES
NO
156. ADDITIONAL DETAILS
157. GENERAL PARKING LOCATIONS
Page 9 of 12

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