Wash. Admin. Code § 446-20-450 – CHRI challenge form

chri challenge form

(request for modification of chri)

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:

Agency	Case No.	Date	Charge
. . . .	. . . .	. . . .	. . . .
. . . .	. . . .	. . . .	. . . .
. . . .	. . . .	. . . .	. . . .
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: Chapters 10.97 and 43.43 RCW. WSR 21-05-044, § 446-20-450, filed 2/11/21, effective 3/14/21. Statutory Authority: RCW 10.97.080 and 10.97.090. WSR 80-08-057 (Order 80-2), § 446-20-450, filed 7/1/80.]