Section 1. A participant in a program in
another state that is similar to the Safe at Home Program may apply for
approval in the Kentucky Secretary of State Safe at Home Program.
(1) The application for recognition shall be
made to the Secretary of State by submitting a completed Application for
Recognition of Out of State Participant, which shall contain:
(a) The applicant's full legal
name;
(b) The applicant's date of
birth;
(c) Any other names that may
appear on the applicant's mail;
(d)
The applicant's county of residence;
(e) The applicant's residential
address;
(f) The applicant's phone
number;
(g) The applicant's email
address;
(h) The applicant's
dependent's legal names and identifying information (if applicable);
(i) The state where the applicant is
currently enrolled;
(j) Contact
information for the other State's administrator of the similar program;
and
(k) Whether the applicant is
permanently moving to the Commonwealth, temporarily living in the Commonwealth,
doing business in the Commonwealth, or engaged in other transactions in the
Commonwealth.
(2) The
application shall include a sworn statement and acknowledge the following:
(a) I am an adult survivor of domestic abuse,
domestic abuse assault, sexual abuse, stalking, or human trafficking, or I am
the parent or guardian of a child or incapacitated individual who is such a
survivor. I fear for my safety, the safety of those who reside in my household,
or the safety of the person on whose behalf I completed this
application;
(b) I am not applying
to participate in the Safe at Home Program to avoid prosecution of any kind. I
confirm that I am not a sexually violent predator;
(c) I give permission to the Secretary of
State's Office to verify my participation in the Safe at Home Program to third
parties when requested;
(d) I
designate the Secretary of State as my agent for service of process and for the
purpose of receipt of mail. If the Secretary of State accepts legal documents
or certified mail addressed to me, it is as if I received them;
(e) I understand that my participation in the
Safe at Home Program may be cancelled if:
1. I
change my legal name and do not notify the Secretary of State's Office in
writing prior to the change;
2.
Mail forwarded by the Secretary of State's Office is returned as undeliverable
by the United States Postal Service;
3. I do not accept service of process or I am
unavailable for delivery of service of process;
4. My application contains false information;
or
5. I become ineligible for the
similar program in the original state certification;
(f) I understand that it is my responsibility
to notify family, friends, businesses, and government agencies of my Safe at
Home Program designated address. I recognize that if I share my confidential
address, the Safe at Home Program cannot control its distribution;
(g) I realize that my mailing address could
include an apartment number and without this apartment number, my mail may be
delayed or may never reach me. I understand the Safe at Home Program shall
forward only first-class, legal, and certified mail, as well as packages of
prescriptions;
(h) I understand
that my approval in the Safe at Home Program is for a one (1) year term. At the
end of this term, I realize that I am required to renew my enrollment or be
cancelled from the program;
(i) I
realize that if I purchase real estate, my information shall appear on public
records;
(j) I understand that I am
required to notify the Safe at Home Program if any of the information on my
original Safe at Home Program application changes;
(k) I understand that once I am enrolled in
the Safe at Home Program, my actual address shall be confidential unless
otherwise ordered by a court or released by the lawful custodian of the record.
The Safe at Home Program may release my information to the Department of Public
Safety, who may release it to law enforcement upon verification that it may aid
in responding to an emergency situation, criminal complaint, or an ongoing
investigation; and
(l) I understand
that my children under the age of eighteen (18) may be enrolled with me as
dependents and that individuals over the age of eighteen (18) are required to
enroll separately. I realize that minors who turn eighteen (18) during
participation in the program shall be responsible for completing a renewal form
at that time to continue Safe at Home Program participation.