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PDFWAC 446-20-450

CHRI challenge form.

chri challenge form
(request for modification of chri)
agency. . . .
 
agency case no. . . . .
address. . . .
 
date. . . .
 
. . . .
 
I, (Print Name) , hereby acknowledge review this date, . . . . . . . . , of a copy of a CHRI rap sheet bearing agency number . . . . . . , or SID number . . . . . . , consisting of . . . . page(s) and identified as a history of criminal offenses charged to me.
I challenge the following specific portion(s) of the CHRI as being inaccurate or incomplete:
Agency
 
Case No.
 
Date
 
Charge
. . . .
 
. . . .
 
. . . .
 
. . . .
. . . .
 
. . . .
 
. . . .
 
. . . .
. . . .
 
. . . .
 
. . . .
 
. . . .
and request modification to read:
I further request, if such modifications are determined to be valid, that all agencies who have received prior copies of the CHRI be advised of the modifications.
 
 
. . . .
(Signature of Challenger)
[Statutory Authority: RCW 10.97.080 and 10.97.090. WSR 80-08-057 (Order 80-2), § 446-20-450, filed 7/1/80.]
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