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Here is the text we could read:

In the District Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

In the Matter of the Name Change of:

_____________________________________
(Minor’s Name)

_______________________________
Case Number

Department of Corrections
Certification Regarding Sex and
Kidnap Offender and Child Abuse
Offender Registries – Minor Child

_______________________________
Judge

Minor’s full name
(first, middle and last)

Date of Birth
(MM/DD/YYYY)

Driver license / state ID
number and state of
issuance (if any)

Department of Corrections Certification Regarding Sex and
Kidnap Offender or Child Abuse Offender Registry – Minor

Approved November 19, 2004
Revised May 14, 2019

Page 1 of 2

ity, State, Zip

Name

ddress

hone

mail

minor

-------------- This section to be completed by Offender Registration Program staff --------------

certify that I searched Utah’s Sex and Kidnap Offender Registry and Child Abuse
Offender Registry for
________________________________________________________________ (name)

[ ] Positive – the above-named person is on the Child Abuse Offender Registry.

[ ] Negative – the above-named person is not on the Child Abuse Offender Registry.

[ ] Other: ___________________________________________________________

ex and Kidnap Offender Registry

[ ] Positive – the above-named person is on the Sex and Kidnap Offender Registry.

[ ] Negative – the above-named person is not on the Sex and Kidnap Offender

[ ] Other: ___________________________________________________________

Sign here ►

Printed Name of Offender
Registration Program staff

Registry.

Date

and the search results were:

hild Abuse Offender Registry

Department of Corrections Certification Regarding Sex and
Kidnap Offender or Child Abuse Offender Registry – Minor

Approved November 19, 2004
Revised May 14, 2019

Page 2 of 2

Instructions

Complete the form. Leave the section that says “This section to be completed by
Offender Registration Program staff” blank.

Address an envelope to yourself with your name and mailing address and put a
stamp on it so that the completed form can be mailed back to you.

Mail the form and your self-addressed stamped envelope to:

Offender Registration Program
14717 Minuteman Drive
Draper, UT 84020

You must mail this form to the Offender Registration Program. They do not have
an office open to the public.

The Offender Registration Program staff will fill out their section and will return
the completed form to you using the envelope you provided.

Once the form is mailed back to you, file it with the court.

Department of Corrections Certification Regarding Sex and
Kidnap Offender or Child Abuse Offender Registry – Minor

Approved November 19, 2004
Revised May 14, 2019

Department of Corrections Certification Regarding Sex and Kidnap Offender and Child Abuse Offender Registries – Minor Child

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 3
Fields(s): 78
Average fields per page: 26
Reading Level: Grade 8
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

users1_name was name (1.00 conf)
users1_address_line_one was address (1.00 conf)
city_state_zip was city__state__zip (0.35 conf)
users1_phone_number was phone (1.00 conf)
email was email (0.38 conf)
page_field__1 was page_0_field_5 (0.31 conf)
district_court_utah was in_the_district_court_of_utah (0.34 conf)
page_field__2 was page_0_field_7 (0.31 conf)
judicial_district was judicial_district (0.38 conf)
page_field__3 was page_0_field_9 (0.31 conf)
court_address was court_address (0.42 conf)
department_corrections was department_of_corrections (0.40 conf)
county was county (0.39 conf)
page_field__4 was page_0_field_13 (0.31 conf)
page_field__5 was page_0_field_14 (0.31 conf)
page_field__6 was page_0_field_15 (0.31 conf)
page_field__7 was page_0_field_16 (0.31 conf)
page_field__8 was page_0_field_17 (0.31 conf)
page_field__9 was page_0_field_18 (0.31 conf)
offender_minor_child was offender_registries_minor_child (0.33 conf)
page_field__10 was page_0_field_20 (0.31 conf)
docket_number was case_number (1.00 conf)
page_field__11 was page_0_field_22 (0.31 conf)
page_field__12 was page_0_field_23 (0.31 conf)
page_field__13 was page_0_field_24 (0.31 conf)
matter_name_change was in_the_matter_of_the_name_change_of (0.35 conf)
page_field__14 was page_0_field_26 (0.31 conf)
minor_name was minor_s_name (0.42 conf)
page_field__15 was page_0_field_28 (0.31 conf)
page_field__16 was page_0_field_29 (0.31 conf)
page_field__17 was page_0_field_30 (0.31 conf)
driver_license_state_id was driver_license_state_id (0.46 conf)
page_field__18 was page_0_field_32 (0.31 conf)
page_field__19 was page_0_field_33 (0.31 conf)
judge was judge (0.39 conf)
corrections_certification_regarding was department_of_corrections_certification_regarding_sex_and (0.39 conf)
utah_offender_child_abuse was i_certify_that_i_searched_utah_s_sex_and_kidnap_offender_registry_and_child_abuse (0.43 conf)
page_field__20 was page_1_field_1 (0.36 conf)
page_field__21 was page_1_field_2 (0.36 conf)
page_field__22 was page_1_field_3 (0.36 conf)
page_field__23 was page_1_field_4 (0.36 conf)
search_results was and_the_search_results_were (0.36 conf)
page_field__24 was page_1_field_6 (0.36 conf)
page_field__25 was page_1_field_7 (0.36 conf)
offender_registry was offender_registry_for (0.44 conf)
page_field__26 was page_1_field_9 (0.36 conf)
page_field__27 was page_1_field_10 (0.36 conf)
page_field__28 was page_1_field_11 (0.36 conf)
child_abuse_offender__1 was negative_the_above_named_person_is_not_on_the_child_abuse_offender_registry (0.39 conf)
child_abuse_offender__2 was positive_the_above_named_person_is_on_the_child_abuse_offender_registry (0.36 conf)
page_field__29 was page_1_field_14 (0.36 conf)
page_field__30 was page_1_field_15 (0.36 conf)
sex_kidnap_offender_registry was sex_and_kidnap_offender_registry (0.44 conf)
page_field__31 was page_1_field_17 (0.36 conf)
page_field__32 was page_1_field_18 (0.36 conf)
child_abuse_offender__3 was child_abuse_offender_registry (0.35 conf)
other was other (0.43 conf)
page_field__33 was page_1_field_21 (0.36 conf)
named_person_kidnap_offender was negative_the_above_named_person_is_not_on_the_sex_and_kidnap_offender (0.36 conf)
page_field__34 was page_1_field_23 (0.36 conf)
page_field__35 was page_1_field_24 (0.36 conf)
users1_signature was sign_here (1.00 conf)
page_field__36 was page_1_field_26 (0.36 conf)
page_field__37 was page_1_field_27 (0.36 conf)
page_field__38 was page_1_field_28 (0.36 conf)
page_field__39 was page_1_field_29 (0.36 conf)
registry was registry (0.47 conf)
page_field__40 was page_1_field_31 (0.36 conf)
page_field__41 was page_1_field_32 (0.36 conf)
signature_date was date (1.00 conf)
page_field__42 was page_1_field_34 (0.36 conf)
page_field__43 was page_1_field_35 (0.36 conf)
page_check__1 was page_1_check_0 (0.33 conf)
page_check__2 was page_1_check_1 (0.26 conf)
page_check__3 was page_1_check_2 (0.26 conf)
named_person_offender was positive_the_above_named_person_is_on_the_sex_and_kidnap_offender_registry (0.38 conf)
page_check__4 was page_1_check_4 (0.26 conf)
page_check__5 was page_1_check_5 (0.26 conf)
approved_november was approved_november_19__2004 (0.43 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Department of Corrections Certification Regarding Sex and Kidnap Offender and Child Abuse Offender Registries – Minor Child

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02