Dps Form 12 699 67 PDF Details

In order to ensure the safety of Oklahoma's students, all school districts are required to submit a completed DPS Form 12 699 67. This form is used to provide information on each district's emergency preparedness plans and procedures. By understanding your district's emergency plan, you can be better prepared in the event of an emergency. For more information on the DPS Form 12 699 67, please visit our website. Thank you for your continued support of our schools.

Form NameDps Form 12 699 67
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesSOR_Uncondition al Discharge_Form_12 299 67 allinurl alaska proof form

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Completed forms must be submitted to:

Sex Offender Registration Office

5700 East Tudor Road, Anchorage, Alaska 99507

Telephone: (907) 269-0396 Fax: (907) 269-0394

The Alaska sex offender/child kidnapper registration law does not apply to offenders who committed their offense(s) before the act became effective on August 10, 1994; or whose sex offense conviction was set aside before December 31, 1995. Sex offenders or child kidnappers convicted of only one non-aggravated offense must register until 15 years after they have been unconditionally discharged. To prove the date of unconditional discharge, these offenders must submit this Proof of Unconditional Discharge form, including signatures from a representative of the Department of Corrections or Court System certifying the unconditional discharge information. Sex offenders or child kidnappers convicted of multiple offenses or one aggravated offense are required to register quarterly and cannot use this form.

To be completed by the sex offender (only persons convicted of one non-aggravated offense)

Offender Information

Court Case Information


Court Case #:


Mailing Address:


Court Location:




Conviction Charge:


State / Zip Code

Statute / Ordinance:


Driver's License #:


Count or Charge #:


Date of Birth:


Conviction Date:






Telephone #:


Probation Length:



If proof of unconditional discharge date is provided from a court order or other court document, a copy must be attached.

To be completed by the Department of Corrections or Court System

Certification of Date of Unconditional Discharge

Agency records indicate that the above named offender was unconditionally discharged, or was discharged from probation for the above listed sex offense, on: _____________________________________________________________

I certify that the above date is true and correct, according to our records.


Signature of Department of Corrections or Court representative











Printed name of representative

Mailing Address










Printed title of representative

Contact number

























AS 12.63.010

Registration of Sex Offenders





AS 12.63.020

Duration of sex offender or child kidnapper duty to register





AS 18.65.087

Central registry of sex offenders





13 AAC 09.044

Proof of Unconditional Discharge




DPS form 12-699-67 (Rev. 10/08)

Sex Offender Registration Requirements

Alaska Statutes 12.63.010 - 100, and the Alaska Administrative Code 13 AAC 09.010 - 900, require the registration of sex offenders and child kidnappers who are physically present in the state. The duty of a sex offender or child kidnapper to comply with requirements as AS 12.63.010 for each sex offense or child kidnapping continues:

(1)for the lifetime of a sex offender or child kidnapper convicted of:

(A)one aggravated offense; or

(B)two or more sex offenses, two or more child kidnappings, or one sex offense and one child kidnapping

(2)for 15 years following the offender's unconditional discharge from a conviction for: - a single offense that is not an aggravated offense; or

- a single child kidnapping

if the offender has provided proof that is acceptable to the department of unconditional discharge.

Registration is tolled (extended) for each year that an offender (i) fails to comply with sex offender requirements, (ii) is incarcerated for any offense, or (iii) is absent from this state and did not register in another state.

Registration is also extended until the offender submits proof acceptable to the department of the date of the offender's unconditional discharge from the probation or parole for the offense requiring registration.

It is the responsibility of the offender to supply proof acceptable to the department of unconditional discharge and the date it occurred.

Proof of Unconditional Discharge


Unconditional Discharge means that the requirements of the sentence, including probation and parole, have been met.

The department will, after verification for accuracy and completeness, consider an offender to have submitted satisfactory proof of unconditional discharge upon receipt of:

(1)a department form that includes the name, mailing address, and phone number of a court or correctional officer who who may be contacted by the department to confirm the offender's assertion of the unconditional discharge date; and

(2)a copy of a court judgment, court order, certificate of unconditional discharge, letter, or other document signed by an employee of a court or correctional agency showing, for the offense for which the offender is required to register,

(A)the unconditional discharge date

(B)the full statute or ordinance citation and descriptive title;

(C)the court case number, and

(D)if assigned by the court, the charge or count number.

When submitting the department's Proof of Unconditional Discharge form, it is the sex offender's responsibility to submit a completed form, including required signatures from the Department of Corrections or the Court System.

Depending on the specific circumstances of your case, the Department of Corrections or the Court System will be able to determine if your conviction has been set aside or if you have been unconditionally discharged. When contacting the Department of Corrections or the Court System, use the following guidelines:

If you were not sentenced to a term of imprisonment, or if your conviction was set aside,contact the court in which you were convicted for unconditional discharge information.

If you received a term of imprisonment, contact the Department of Corrections, Central Records, 802 3rd Street, Douglas, Alaska, 99824, for unconditional discharge information. To fax requests, contact Central Records at (907) 465- 3482 for more information.

When submitting a copy of a court order, letter, or other document as proof of unconditional discharge, the sex offender must complete the top part of the Proof of Unconditional Discharge form and attach documentation.

DPS form 12-699-67 (Previously 12-699-68 Rev. 10/08)

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