IN THE DISTRICT COURT OF __________________ COUNTY

STATE OF OKLAHOMA
STATE OF OKLAHOMA )
Plaintiff, )
v. ) Case No. _________
_________________________________, )
Defendant. )
METHAMPHETAMINE OFFENDER REGISTRATION
Defendant Information
Last Name Fi!st Name Middle Name
Add!ess
Cit" State #i$
Add!ess Home %o!& Ot'e! P'one (Home) P'one (Cell)
Email Date of )i!t'
D.L. * D.L. State +ende! Male Female
Coni!tion " P#ea
Offense(s) Ad,-di.ation Date Len/t' of Senten.e 0-d/e
Noti!e to Defendant
T'is .onvi.tion of, o! $lea to, a met'am$'etamine1!elated offense ma&es "o- s-2,e.t to t'e O&la'oma
Met'am$'etamine Offende! 3e/ist!" A.t (See 63 O.S. 2-701).
%'ile s-2,e.t to t'e O&la'oma Met'am$'etamine Offende! 3e/ist!" A.t, "o- a!e $!o'i2ited f!om $-!.'asin/,
$ossessin/, o! 'avin/ .ont!ol of an" s-2stan.e .ontainin/ an" amo-nt of $se-doe$'ed!ine. A $!es.!i$tion fo!
$se-doe$'ed!ine s'all not $!ovide an e4em$tion fo! an" $e!son to t'is la5. T'is is in addition to an" ot'e! te!ms, !-les
o! .onditions of "o-! senten.e, $!o2ation, o! $a!ole. Fo! mo!e info!mation, .ons-lt 63 O.S. 2-701.
)" si/nin/ t'is fo!m, t'e Defendant attests t'at t'e Defendant 'as !ead o! t'e info!mation .ontained 'e!ein 5as !ead to
t'e Defendant. F-!t'e!, t'e Defendant attests t'at t'e a2ove info!mation is t!-e and a..-!ate.
Defendant a.&no5led/es t'at an" .'an/e $e!tainin/ to info!mation t'at is $!ovided a2ove m-st 2e $!ovided to t'e
O&la'oma )-!ea- of Na!.oti.s Met'am$'etamine 3e/ist!" in 5!itin/ 5it'in t'i!t" (67) da"s t'e!eof.
________________________________ ________________________________
Defendant Atto!ne" fo! Defendant
__________________________________ __________________________________
Assistant Dist!i.t Atto!ne" Pa!don8Pa!ole Offi.e! 9 P'one N-m2e!
O$#a%oma &'rea' of Nar!oti!( and Dan)ero'( Dr')(
Fa* or Mai# form to+ Met%am,%etamine Re)i(tration- ../ NE 01
t%
Street- O$#a%oma Cit2- OK 304/5
P%one+ 63378937983. Fa*+ ./5759.73841