Please provide the following information.

* Denotes a required field.

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Offender MDOC Number (if known):

OFFENDER SEARCH  

*Offender First Name:

*Offender Last Name:

Offender Date of Birth:

Offender Race:

Offender Gender: MALE FEMALE

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*County of Conviction: SELECT ONE.. ADAMS ALCORN AMITE ATTALA BENTON BOLIVAR CALHOUN CARROLL CHICKASAW CHOCTAW CLAIBORNE CLARKE CLAY COAHOMA COPIAH COVINGTON DESOTO FORREST FRANKLIN GEORGE GREENE GRENADA HANCOCK HARRISON HINDS HOLMES HUMPHREYS ISSAQUENA ITAWAMBA JACKSON JASPER JEFFERSON JEFFERSON DAVIS JONES KEMPER LAFAYETTE LAMAR LAUDERDALE LAWRENCE LEAKE LEE LEFLORE LINCOLN LOWNDES MADISON MARION MARSHALL MONROE MONTGOMERY NESHOBA NEWTON NOXUBEE OKTIBBEHA PANOLA PEARL RIVER PERRY PIKE PONTOTOC PRENTISS QUITMAN RANKIN SCOTT SHARKEY SIMPSON SMITH STONE SUNFLOWER TALLAHATCHIE TATE TIPPAH TISHOMINGO TUNICA UNION WALTHALL WARREN WASHINGTON WAYNE WEBSTER WILKINSON WINSTON YALOBUSHA YAZOO

*Crime(s):

*Date Crime was Committed:

Date of Sentencing:

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What, if any, is your relationship to this offender?

Do you currently have an active Protection/Restraining Order against this offender? YES NO

Are you currently being threatened by this offender? YES NO

Please briefly explain nature of threat:

Are you the person against whom the criminal offense was committed? YES NO

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