HomeMy Public PortalAboutSex Offender InformationThe Commonwealth of Massachusetts
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Executive Office of Public Safety
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Sex Offender Registry Board
Post Office Box 4547
DEVAL L. PATRICK
Salem, MA 01970-4547
Governor
(978) 740-6400
TIMOTHY P. MURRAY
Lieutenant Govenor
Fax: (978) 740-6464
REQUEST FOR SEX OFFENDER INFORMATION
FROM CITY/TOWN POLICE DEPARTMENTS (M.G.L. c. 6, § 178J)
KEVIN M. BURKE
Secretary
JENNIFER FRANCO
Chairperson
You may request from your city/town police department whether: a specific individual identified
by name, date of birth or sufficient personal identifying characteristics is a sex offender; or
whether any sex offenders live or work within the same city or town of a specific address. You
may specify the address of a home, school, daycare facility, playground, etc.; or whether any sex
offenders live or work on a specific street.
In response to your request, you will receive a report which indicates the name of the offender,
the home address, the work address, the offense(s) and date(s) for which the offender was
convicted/adjudicated, the offender's age -sex -race -height -weight -eye and hair color, and a
photograph if available.
Please be advised that the law only permits the public to receive information on sex offenders
required to register and finally classified by the Sex Offender Registry Board as a level 2
(moderate risk) or level 3 (high risk) offender. Therefore, information is not available to the
public if the sex offender is a level 1 (low risk) offender or if he/she has not yet been finally
classified by the Board.
All inquiries shall be recorded and kept confidential; provided that the records may be
disseminated to assist or defend any criminal prosecution.
NAME OF REQUESTOR:
� a a aX11
CITY/TOWN, STATE,ZIP:
TELEPHONE:
DATE OF BIRTH:
IDENTIFICATION PRESENTED:
DATE/TIME OF REQUEST:
SOR Form 5 (01/01)
If you are inquiring whether an individual is a sex offender, please complete the following
section:
SUBJECT'S NAME:
PERSONAL IDENTIFYING CHARACTERISTICS:
SEX: RACE:
D.O.B./APPROXIMATE AGE:
ADDRESS:
HGT: WGT: EYE COLOR: HAIR COLOR:
OTHER PERTINENT INFORMATION (i.e. vehicle license plate number, parent information):
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If you are inquiring whether any sex offenders live or work on a specific street, please
complete the following section:
STREET:
CITY/TOWN:
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If you are inquiring whether any sex offenders live or work within the same city or town of
a specific address, please complete the following section:
ADDRESSES:
" I understand that the sex offender registry information disclosed to me is intended for my
own protection or for the protection of a child under the age of 18 or another person for
whom I have responsibility, care or custody." M.G.L. c. 6, § 178J(a)(4)
SIGNATURE OF REQUESTOR:
**********WARNING**********
SEX OFFENDER REGISTRYINFORMATION SHALL NOT BE USED TO COMMIT A CRIME OR TO ENGAGE IN
ILLEGAL DISCRIMINATION OR HARASSMENT OF AN OFFENDER. ANY PERSON WHO USES INFORMATION
DISCLOSED PURSUANT TO M. G.L. C. 6, §§ 178C -178P FOR SUCH PURPOSES SHALL BE PUNISHED BY NOT MORE
THAN TWO AND ONE HALF (2 %) YEARS IN HOUSE OF CORRECTION OR B Y A FINE OF NOT MORE THAN ONE
THOUSAND DOLLARS ($1000.00) OR BOTH (M.G.L. C. 6, § 178N). INADDITION, ANYPERSON WHO USES REGISTRY
INFORMATION TO THREATEN TO COMMIT A CRIME MAYBE PUNISHED BYA FINE OF NOT MORE THAN ONE
HUNDRED DOLLARS ($100.00) OR BYIMPRISONMENT FOR NOT MORE THANSIX (6) MONTHS (M.G.L. C. 275, § 4).
SOR Form 5 (01/01)