CHRI challenge form.
chri challenge form
(request for modification of chri)
agency. . . . | | agency case no. . . . . |
address. . . . | | date. . . . |
| . . . . | |
I, (Print Name) , Date of Birth hereby acknowledge receipt this date, . . . . . . . . , of a copy of a Washington State Patrol Criminal Records Division RAPsheet bearing 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 that the following designated persons or agencies who have received copies of the record be advised of the modifications. |
| | . . . . (Signature of Requestor) Prints of right four fingers taken simultaneously together |
[Statutory Authority: Chapters
10.97 and
43.43 RCW. WSR 21-05-044, § 446-20-450, filed 2/11/21, effective 3/14/21. Statutory Authority: RCW
10.97.080 and
10.97.090. WSR 80-08-057 (Order 80-2), § 446-20-450, filed 7/1/80.]