New Jersey Judiciary
Additional Questions for Certain Sexual Offenses
Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10080-English page 1 of 4
These additional questions need to be answered if you are pleading guilty to the offense of aggravated
sexual assault, sexual assault, aggravated criminal sexual contact, kidnapping under 2C:13-1c(2),
endangering the welfare of a child by engaging in sexual conduct which would impair or debauch the
morals of the child under 2C:24-4a, endangering the welfare of a child pursuant to 2C:24-4b(3), (4) or
(5)(a), luring or enticing a child pursuant to 2C:13-6, criminal sexual contact pursuant to 2C:14-3b if the
victim is a minor; kidnapping pursuant to 2C:13-1, criminal restraint pursuant to 2C:13-2 or false
imprisonment pursuant to 2C:13-3 if the victim is a minor and the offender is not the parent, promoting
child prostitution pursuant to 2C:34-1b(3), (4), or any attempt to commit any such offense. Note also
that Question 7 includes the offense of felony murder if the underlying crime is sexual assault, as well as
any offense for which the court makes a specific finding on the record that, based on the circumstances
of the case, the offense should be considered a sexually violent offense, or an attempt to commit these
offenses.
1. Registration
a) Do you understand that you must register with certain public agencies? [Yes] [No]
b) Do you understand that if you change residence you must notify the law
enforcement agency where you are registered, and must re-register with the
chief law enforcement officer of the municipality in which you will reside, or
the Superintendent of State Police if the municipality doesnot have a chief law
enforcement officer, no less than 10 days before you intend to reside at the
new address?
[Yes] [No]
c) Do you understand that if you fail to register or re-register you may be charged
with a third degree crime and receive a sentence of imprisonment of up to 5
years?
[Yes] [No]
d) Do you understand that you must provide the appropriate law enforcement
agency with information about your routine access to or use of a computer or
device with Internet capability? (if the offense was committed on or after
February 25, 2008)
[Yes] [No]
e) Do you understand that if you fail to notify the appropriate law enforcement
agency about your routine access to or use of a computer or device with
Internet capability or a change in such use or access, you may be charged with
a fourth degree crime and may receive a sentence of imprisonment of up to 18
months? (if the offense was committed on or after February 25, 2008)
[Yes] [No]
Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10080-English page 2 of 4
2. Address Verification
a) Do you understand that if you are pleading guilty to aggravated sexual assault,
sexual assault, aggravated criminal sexual contact, kidnapping pursuant to
2C:13-1c(2) or any attempt to commit any of these crimes and at sentencing
the court finds that your conduct was characterized by a pattern of repetitive,
compulsive behavior you must verify your address with the appropriate law
enforcement agency every 90 days or if the court finds your conduct is not
characterized by a pattern of repetitive and compulsive behavior, you must
verify your address annually?
[Yes] [No]
b) Do you understand that if you provide false information concerning your
residence or fail to verify your address you may be charged with a fourth
degree crime and receive a sentence of imprisonment of up to 18 months?
[Yes] [No]
3. Notification
Do you understand that the requirement of registration may result in notification to
law enforcement, community organizations, or the public at large, of your release
from incarceration or presence in the community?
[Yes] [No]
4a. Community Supervision for Life (only complete if the offense occurred before
January 14, 2004). (If the offense occurred on or after January 14, 2004, the
defendant should complete Question 4b, Parole Supervision for Life).
(1) Do you understand that if you are pleading guilty to the crime of aggravated
sexual assault, sexual assault, aggravated criminal sexual contact, kidnapping
pursuant to 2C:13-1c(2), endangering the welfare of a child by engaging in
sexual conduct which would impair or debauch the morals of the child
pursuant to 2C:24-4a, luring, or an attempt to commit any such offense, the
court, in addition to any other sentence, will impose a special sentence of
community supervision for life?
[Yes] [No]
(2) Do you understand that being sentenced to community supervision
for life means that: you will be supervised for at least 15 years as if
on parole, and subject to conditions appropriate to protect the
public and foster rehabilitation, including, but not limited to
counseling; Internet access or use; and other restrictions, which
may include restrictions on where you can live, work or travel?
[Yes] [No] [NA]
(3) Do you understand that the restrictions on where you can live may
include restrictions on residing in a home with minor children? [Yes] [No] [NA]
Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10080-English page 3 of 4
4b. Parole Supervision for Life (only complete if the offense occurred on or after
January 14, 2004).
(1) Do you understand that if you are pleading guilty to the crime of
aggravated sexual assault, sexual assault, aggravated criminal
sexual contact, kidnapping pursuant to 2C:13-1c(2), endangering
the welfare of a child by engaging in sexual conduct which would
impair or debauch the morals of a child pursuant to 2C:24-4a,
endangering the welfare of a child pursuant to 2C:24-4b(3), luring
or an attempt to commit any of these offenses and the offense
occurred on or after January 14, 2004, the court, in addition to any
other sentence, will impose a special sentence of parole supervision
for life?
[Yes] [No] [NA]
(2) Do you understand that being sentenced to parole supervision for
life means that upon release from incarceration or immediately
upon imposition of a suspended sentence you will be supervised by
the Division of Parole for at least 15 years and will be subject to
provisions and conditions of parole, including conditions
appropriate to protect the public and foster rehabilitation, such as,
but not limited to, counseling, Internet access or use, and other
restrictions which may include restrictions on where you can live,
work, travel or persons you can contact?
[Yes] [No] [NA]
(3) Do you understand that the restrictions on where you can live may
include restrictions on residing in a home with minor children? [Yes] [No] [NA]
(4) Do you understand that if you violate a condition of parole
supervision for life, your parole may be revoked and you can be
sent to prison for 12 to 18 months for each revocation that occurs
while you are being supervised and that the prison term you receive
cannot be reduced by commutation or work credits?
[Yes] [No] [NA]
(5) Do you understand that if you violate a condition of parole
supervision for life and you are indicted and convicted for that
violation, you will receive a sentence of imprisonment of up to 18
months and that the sentence you receive could be in addition to
any prison term you may receive from the Parole Board for a
violation of parole supervision for life?
[Yes] [No] [NA]
5. Internet Posting
Do you understand that as a result of your conviction your name, age, race, sex,
date of birth, height, weight, eye color, any distinguishing scars or tattoos you
have, your photograph, the make, model, color, year and license plate number of
any vehicle you operate, the street address, zip code, municipality and county in
which you reside and a description of the offense for which you are pleading
guilty, may be publicly available on the Internet?
[Yes] [No]
Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10080-English page 4 of 4
6. Statewide Sexual Assault Nurse Examiner Program Penalty
Do you understand that if the crime occurred on or after May 4, 2001 as a result of
your guilty plea you will be required to pay a penalty of $800 for each offense for
which you are pleading guilty?
[Yes] [No]
7. Civil Commitment
Do you understand that if you are convicted of a sexually violent offense, such as
aggravated sexual assault, sexual assault, aggravated criminal sexual contact,
kidnapping under 2C:13-1c(2)(b), criminal sexual contact, felony murder if the
underlying crime is sexual assault, an attempt to commit any of these offenses, or
any offense for which the court makes a specific finding on the record that, based
on the circumstances of the case, the offense should be considered a sexually
violent offense, you may upon completion of your term of incarceration, be civilly
committed to another facility for up to life if the court finds, after a hearing, that
you are in need of involuntary civil commitment?
[Yes] [No]
8. Sex Crime Victim Treatment Fund Penalty (S.C.V.T.F.)
Do you understand that if the crime occurred on or after April 26, 2005, as a result
of your guilty plea you will be required to pay a mandatory Sex Crime Victim
Treatment Fund (S.C.V.T.F.) penalty as listed below for each offense for which
you pled guilty?
[Yes] [No]
b. The mandatory penalties are as follows:
(1) Up to $2,000 in the case of a 1st degree crime
(2) Up to $1,000 in the case of a 2nd degree crime
(3) Up to $ 750 in the case of a 3rd degree crime
(4) Up to $ 500 in the case of a 4th degree crime
TOTAL S.C.V.T.F. Penalty: $
Date: Defendant:
Defense Attorney:
Prosecutor:
