| Check all that apply | Crime | Self | Other household member | Date of conviction, guilty plea, no contest plea or pending charges | Sentence |
|---|
| 18 Pa.C.S. § 4304 (relating to endangering welfare of children) | | | | |
| 18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal) | | | | |
| 18 Pa.C.S. § 5543 (relating to animal fighting) | | | | |
| 18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia) | | | | |
| 18 Pa.C.S. § 5902(b) or (b.1) (relating to prostitution and related offenses) | | | | |
| 18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances) | | | | |
| 18 Pa.C.S. § 6301 (relating to corruption of minors) | | | | |
| 18 Pa.C.S. § 6312 (relating to sexual abuse of children) | | | | |
| 18 Pa.C.S. § 6318 (relating to unlawful contact with minor) | | | | |
| 18 Pa.C.S. § 6320 (relating to sexual exploitation of children) | | | | |
| Finding of contempt of a Protection from Abuse order or agreement under 23 Pa.C.S. § 6114 | | | | |
| Finding of contempt of a Protection of Victims of Sexual Violence and Intimidation order or agreement under 42 Pa.C.S. § 62A14 | | | | |
| Driving under the influence of drugs or alcohol | | | | |
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. § 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) or (b.1) (relating to prostitution and related offenses)
Sentence_18 Pa.C.S. § 5902(b) or (b.1) (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. § 6312 (relating to sexual abuse of children)
Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6320 (relating to sexual exploitation of children)
Sentence_18 Pa.C.S. § 6320 (relating to sexual exploitation of children)
Date of conviction, guilty plea, no contest plea or pending charges_Finding of contempt of a Protection from Abuse order or agreement under 23 Pa.C.S. § 6114
Sentence_Finding of contempt of a Protection from Abuse order or agreement under 23 Pa.C.S. § 6114
Date of conviction, guilty plea, no contest plea or pending charges_Finding of contempt of a Protection of Victims of Sexual Violence and Intimidation order or agreement under 42 Pa.C.S. § 62A14
Sentence_Finding of contempt of a Protection of Victims of Sexual Violence and Intimidation order or agreement under 42 Pa.C.S. § 62A14
Date of conviction, guilty plea, no contest plea or pending charges_Driving under the influence of drugs or alcohol
Sentence_Driving under the influence of drugs or alcohol