Washington Administrative Code
Title 446 - State Patrol (See also Titles 204, 212 and 448)
Chapter 446-20 - Employment-Conviction records
Section 446-20-450 - CHRI challenge form

CHRI CHALLENGE FORM

(REQUEST FOR MODIFICATION OF CHRI)

RCW 10.97.080/WAC 446-20-120

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:

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: RCW 10.97.080 and 10.97.090. 80-08-057 (Order 80-2), § 446-20-450, filed 7/1/80.