Form B: Description of Offense

Instructions

Please complete the appropriate number of FORM B to include all offenses you must report. Include ONLY ONE OFFENSE per form. Check the appropriate box to indicate either "Felony" or "Misdemeanor". Once you complete the 1st Form B, if you need an additional Form B for another offense, make sure to select another Form B.

First Name

Middle Name

Last Name

Date of Birth (MM/DD/YYY)

Social Security Number

Date Range of
Offense

FROM (MM/DD/YYYY)

THROUGH (MM/DD/YYYY)

Nature of the Offense

Felony Misdemeanor

Describe:

Name of Court(s) Involved

Punishment Imposed

Disposition
(Where do you stand with this case currently?)

When you have completed and verified this FORM B, please click on SUBMIT FORM.

Form B: Description of Offense

Instructions

Date Range of Offense

Nature of the Offense

Date Range of
Offense