Check YES to all that apply	Check NO to all that DO NOT apply	Crime	Self	Other household member	Date of conviction, guilty plea, no contest plea or pending charges	Sentence
YES☐	NO☐	18 Pa.C.S. § 3301 (relating to arson and related offenses)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 4302 (relating to incest)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 4303 (relating to concealing death of child)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 4304 (relating to endangering welfare of children)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 4305 (relating to dealing in infant children)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5533 (relating to cruelty to animal)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5543 (relating to animal fighting)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5902(b) (relating to prostitution and related offenses)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 6301 (relating to corruption of minors)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 6312 (relating to sexual abuse of children)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 6318 (relating to unlawful contact with minor)	undefined	NO	undefined	undefined

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3301 (relating to arson and related offenses)

Sentence_18 Pa.C.S. § 3301 (relating to arson and related offenses)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 4302 (relating to incest)

Sentence_18 Pa.C.S. § 4302 (relating to incest)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 4303 (relating to concealing death of child)

Sentence_18 Pa.C.S. § 4303 (relating to concealing death of child)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 4304 (relating to endangering welfare of children)

Sentence_18 Pa.C.S. § 4304 (relating to endangering welfare of children)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 4305 (relating to dealing in infant children)

Sentence_18 Pa.C.S. § 4305 (relating to dealing in infant children)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5533 (relating to cruelty to animal)

Sentence_18 Pa.C.S. § 5533 (relating to cruelty to animal)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal)

Sentence_18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5543 (relating to animal fighting)

Sentence_18 Pa.C.S. § 5543 (relating to animal fighting)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia)

Sentence_18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5902(b) (relating to prostitution and related offenses)

Sentence_18 Pa.C.S. § 5902(b) (relating to prostitution and related offenses)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances)

Sentence_18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6301 (relating to corruption of minors)

Sentence_18 Pa.C.S. § 6301 (relating to corruption of minors)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6312 (relating to sexual abuse of children)

Sentence_18 Pa.C.S. § 6312 (relating to sexual abuse of children)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6318 (relating to unlawful contact with minor)

Sentence_18 Pa.C.S. § 6318 (relating to unlawful contact with minor)