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. § 2709.1 (relating to stalking)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2718 (relating to strangulation)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2901 (relating to kidnapping)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2902 (relating to unlawful restraint)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2903 (relating to false imprisonment)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2904 (relating to interference with custody of children)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 2910 (relating to luring a child into a motor vehicle or structure)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3121 (relating to rape)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3122.1 (relating to statutory sexual assault)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3124.1 (relating to sexual assault)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3125 (relating to aggravated indecent assault)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3126 (relating to indecent assault)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3127 (relating to indecent exposure)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3129 (relating to sexual intercourse with animal)	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 3130 (relating to conduct relating to sex offenders)	undefined	NO	undefined	undefined

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2709.1 (relating to stalking)

Sentence_18 Pa.C.S. § 2709.1 (relating to stalking)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2718 (relating to strangulation)

Sentence_18 Pa.C.S. § 2718 (relating to strangulation)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2901 (relating to kidnapping)

Sentence_18 Pa.C.S. § 2901 (relating to kidnapping)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2902 (relating to unlawful restraint)

Sentence_18 Pa.C.S. § 2902 (relating to unlawful restraint)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2903 (relating to false imprisonment)

Sentence_18 Pa.C.S. § 2903 (relating to false imprisonment)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2904 (relating to interference with custody of children)

Sentence_18 Pa.C.S. § 2904 (relating to interference with custody of children)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 2910 (relating to luring a child into a motor vehicle or structure)

Sentence_18 Pa.C.S. § 2910 (relating to luring a child into a motor vehicle or structure)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3121 (relating to rape)

Sentence_18 Pa.C.S. § 3121 (relating to rape)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3122.1 (relating to statutory sexual assault)

Sentence_18 Pa.C.S. § 3122.1 (relating to statutory sexual assault)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse)

Sentence_18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3124.1 (relating to sexual assault)

Sentence_18 Pa.C.S. § 3124.1 (relating to sexual assault)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3125 (relating to aggravated indecent assault)

Sentence_18 Pa.C.S. § 3125 (relating to aggravated indecent assault)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3126 (relating to indecent assault)

Sentence_18 Pa.C.S. § 3126 (relating to indecent assault)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3127 (relating to indecent exposure)

Sentence_18 Pa.C.S. § 3127 (relating to indecent exposure)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3129 (relating to sexual intercourse with animal)

Sentence_18 Pa.C.S. § 3129 (relating to sexual intercourse with animal)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 3130 (relating to conduct relating to sex offenders)

Sentence_18 Pa.C.S. § 3130 (relating to conduct relating to sex offenders)