VIRGINIA CIVIL RIGHTS RESTORATION GUIDE

VIRGINIA CIVIL RIGHTS RESTORATION GUIDE Fall 2011 Virginia is one of only four states in the country whose laws forever strip individuals civil rights upon a felony conviction, including their right to vote, unless individually restored by the Governor. To date, hundreds of thousands of Virginians had been stripped of their rights to vote, run for public office, serve on a jury, and serve as a public notary. This restoration guide contains step-by-step instructions on how to determine eligibility and how to apply directly to the Governor for restoration or petition the court for initial review. It also contains application forms, criminal code reference tables, public notary information, and instructions on how to obtain or correct identification.

In Virginia, any person convicted of a felony is stripped of certain civil rights forever. New Virginia residents who have not restored their civil rights in the state of their conviction(s) also are stripped of their rights. These rights, however, can be restored through an appeal to the Governor of Virginia. This guide explains the process for restoring your civil rights, including your right-to-vote. There are three different methods to do this depending on your circumstances: A) Short application for non-violent offenses; B) Long application for violent, drug, election law and all other offenses, and C) Petition to the court for non-violent offenses. Part 1: Frequently Asked Questions about VA s Rights Restoration Process 1. How do I know whether my civil rights have been taken away? If you are convicted of a felony offense your civil rights have been taken away, including your right to vote, right to run for public office, right to serve on a jury, and right to serve as a notary public, in Virginia. A felony conviction can come from a guilty plea to a felony charge or trial conviction by a judge or jury. It is important to know that your right to vote was stripped away if you are a Virginia resident OR if you were convicted by a Virginia court. This is even true if you have a federal felony conviction or a felony conviction from another state and you have not had your rights restored from the state of your conviction. 2. If my civil rights were taken, can I immediately apply to restore my rights? Unfortunately you cannot. First, you cannot restore your rights if you are incarcerated, on probation, parole, or still have outstanding court-imposed fines or fees. You must have completed your full sentence. Second, you must become eligible. You become eligible when, if you were convicted of a non-violent felony offense, you wait two years without any other convictions (felony or misdemeanor) from the end of your sentence. If you were convicted of a violent or election-related offense, you must wait five years without any other convictions. Also, you may not be eligible if you have certain criminal convictions or pending cases. If you have completed the waiting period, and have no disqualifying criminal convictions or charges, only then can you apply to the Governor to restore your rights. If you have a suspended sentence you should be able to apply for restoration without delay (instead of waiting until the sentence is technically complete) if you meet every other condition. Governor McDonnell has processed applications by individuals with suspended sentences, and has not stated that a suspended sentence will prevent a person from immediately submitting an application. This means if you have a judgment for a suspended sentence, and do not serve a jail, prison, or other confinement sentence, then the two year or five year waiting period immediately begins assuming that you have paid all of your fines, court costs, etc. If you have a judgment for a suspended sentence, and serve a jail, prison or other confinement sentence, the two-year or five-year waiting period immediately begins upon your release from confinement, assuming that you have paid all of your fines, court fees, etc. If you have a judgment for a suspended sentence, and either have no confinement sentence, or have finished your confinement sentence, but have not paid your outstanding fines, court fees or other financial obligations, then the two-year or five-year waiting period does not begin until you have paid all of your obligations.

3. Should I complete an application or petition the court? Most people complete applications instead of petitioning to the Circuit Court. The application process is usually easier and more straightforward. Submitting a Circuit Court petition can be quicker, but even if the court approves the petition, the Governor still must approve it. The important part is to know that there are two channels for people with non-violent felony convictions to restore their civil rights. 4. How long does the process take? It depends on whether you submit an application or petition a Circuit Court. Governor McDonnell s policy is to make decisions on completed applications within 60 days. Many submitted applications are not accepted by the Secretary of the Commonwealth (on behalf of the Governor) because they are considered incomplete (without all of the requested materials). The Secretary of the Commonwealth has stated, however, that it can request some materials on the applicant s behalf, but doing so may delay the application. It is important to know if you submit a completed application and your application is denied by the Governor, you must wait one-year before you can re-apply. If you petition the Circuit Court it will take time for the court to review the petition. It could be weeks to months depending on the court. Once a petition is approved by the court, the Governor must provide a decision within 90 days from the court s ruling, under Virginia law. Please keep in mind that these rules are not always observed, and it is your right to request that the Governor follow his/her own rules or Virginia law. 5. If I restore my civil rights is that the same as a pardon? Does it expunge my record? No. The restoration of your civil rights is not the same as a pardon or expungment. Neither is granted if you successfully restore your rights. A pardon is a statement of official forgiveness by the Governor. An expungement is when a conviction is removed from your criminal record. Both pardons and expungements are very rarely given (more so than restoration of rights applications). If you restore your civil rights, however, you re-gain your right-to-vote, right to run for public office, right to serve on a jury, and right to serve as a notary public. 6. How do I know whether my conviction is non-violent or violent or which application form to fill-out? For some people whether your conviction was non-violent or violent is obvious. But for others it is not. Governor McDonnell, through the Secretary of the Commonwealth, has provided a list of offenses which he considers nonviolent and violent online, which is in Appendix C of this guide. For some people determining which application to fill-out is hard because you may have non-violent and violent convictions. If this is the case, you should fill-out the violent application. One important thing to keep in mind is that there is a slightly different list for the court petition process than for the application process. Please check Appendices C & D for each list. 7. Can I restore my right to carry a firearm through this process? No. It is illegal for any person convicted of a felony to possess or transport a firearm or carry a concealed weapon in Virginia. To restore this right you must first restore your civil rights, and then you must petition the court for a firearm permit. It is a separate process from civil rights restoration. 8. Is the process to restore civil rights in Virginia the same as other states? No. Virginia is one of four states which permanently remove a person s civil rights, including the right-to-vote, after being convicted of a felony. Most states allow some people to have their rights automatically restored once they serve their sentence. For more information about rights restoration, visit The Sentencing Project s page on Voting Rights, at http://www.sentencingproject.org/template/page.cfm?id=133.

Part 2: Short Application for Non-Violent Convictions You need to answer yes to all of the below questions in order to successfully submit short application: (1) Was conviction for a felony offense? (2) Was it a non-violent offense? (3) Has it been at least two years since completion of the felony sentence? (4) Has it been at least two years since any subsequent conviction, whether felony or misdemeanor? (5) Have all court costs, fines and restitution been paid? Note: Even if all of the answers to above questions are yes, the Governor still has discretion to reject the application. (1) Was the conviction for a felony offense? Voting rights are only taken away for felony convictions. Misdemeanor offenses do not strip you of your civil rights. If you were convicted of a felony offense, go to question 2. If no, you have still have your civil rights. Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C, in the back of this guide. If you are still are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted. If you were not convicted by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently reside. We have provided a list of Clerks in Appendix E. (2) Was the conviction for a non-violent offense? If you choose to apply for restoration there is a short application for non-violent convictions and a long application for violent convictions. Some drug convictions and election-related convictions are considered violent. If you were convicted of a non-violent felony, go to question 3. If you were convicted of a violent felony, go to Part 3, question 2, on page 5. If you are not sure whether your conviction qualifies as non-violent or violent, please Appendix C. If you are still unsure, contact the Micah Womak, Director of Rights Restoration, or Candice Reid, Assistant Director, at the Secretary of the Commonwealth office, at (804)786-2441. If you do not receive a reply, please contact Advancement Project at 1-855-LET-VOTE. (3) Has it been at least two years since your sentence for the felony conviction was completed (including parole, probation, and the payment of court-imposed fees)? If yes, go to question 4. If no, you must wait until this time period has passed before you can apply. (4) Have you been free from any convictions, including both felonies and misdemeanors, in the last two years? If yes, go to question 5. If no, you need to submit a long application explained in Part 3. (5) Have all court costs, fines and restitution been paid? If yes, you should be eligible to complete the short application, please see Appendix A. If no, these must be paid in order to submit an application.

If no, you are not eligible to complete the short application until you have paid all of your court fines, restitution, and fees. If you are not sure please contact either the Clerk of the Court in which you were convicted. If your conviction was not in a Virginia Circuit Court, please call the Circuit Court where you reside. If you are on parole or probation, your officer should be able to assist you.

Part 3: Long Application for Violent, Election Law, Certain Drug and All Other Offenses For violent, election law, and certain drug felony offenses, successful use of the long application requires an answer of yes to the following questions: (1) Was conviction for a felony offense? (2) Has it been at least five years since completion of felony sentence (including suspended sentences, probation and parole)? (3) Have there been no subsequent convictions for felony or misdemeanor offenses in the last five years? (4) Have all court costs, fines, and restitution been paid? Note: Even if all of the answers to above questions are yes, the Governor still has discretion to reject the application. (1) Was conviction for a felony offense? Voting rights are only taken away for felony convictions. Misdemeanor offenses do not strip you of your civil rights. If you were convicted of a felony offense, go to question 2. If no, you still have your civil rights. Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C. If you are still are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted. If you were not convicted by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently reside. We have provided a list of Clerks in Appendix E. (2) Has it been at least five years since you completed your felony sentence (including probation, parole or the payment of court-imposed fees)? If yes, go to question 3. If no, you may need to wait until five years has passed since your most recent conviction before you can apply. Note: Technically this question refers only to felony convictions. If you have had a misdemeanor conviction, however, within five years since you completed your felony sentence, then your application will most likely NOT be approved. Ultimately, you should make your own decision about whether to still submit your application. Please keep in mind that if you submit an application and your application is rejected there is a one-year mandatory waiting period until you can re-apply. (3) Have you had a felony or misdemeanor conviction in the last five years? If no, go to question 4. If no, you may need to wait until this time period has passed before you can apply. Note: Technically this question only refers to convictions charges that have been accepted by guilty plea or under which a jury or judge has found you guilty in a trial. If, however, you have a misdemeanor case that is continued (postponed) and scheduled to be dismissed, the application will most likely NOT approved until the case is actually dismissed. Ultimately, you should make your own decision about whether to still submit your application. Please keep in mind that if you submit an application and your application is rejected there is a one-year mandatory waiting period until you can re-apply.

(4) Have all court costs, fines, and restitution been paid? If yes, you are eligible to complete the long application, please see Appendix B. If no, costs must be paid to submit an application. If no, you are not eligible to complete the long application until you have paid all of your court fines, restitution, and fees. If you are not sure, please contact either the Clerk of the Court in which you were convicted. If your conviction was not in a Virginia Circuit Court, please call the Circuit Court where you reside. If you are on parole or probation, your officer should be able to assist you. Where should I send my completed application? Once completed, the application should be sent to: Secretary of the Commonwealth Attn: Clemency Division Post Office Box 2454 Richmond, Virginia 23218-2454 After the Secretary s Office determines that your application meets the eligibility requirements, it is forwarded to the Governor for final approval. Where can I find more information about the application process? More information can be found at: http://www.commonwealth.virginia.gov/judicialsystem/clemency/restoration.cfm. State government contact: Micah Womak, Director of Rights Restoration or Candice Reid, Assistant Director Office of the Secretary of the Commonwealth Post Office Box 2454 Richmond, Virginia 23218-2454 (804)786-2441 Additional assistance can be provided by: Advancement Project 1220 L Street NW, Suite 850 Washington DC, 20005 1-855-LET-VOTE

Part 4: Petition to Court for Non-Violent Offenses A petition is simply a request for restoration of voting rights submitted to the court. In deciding whether to approve a petition, the court will evaluate answers to the following questions: In order to successfully petition the court, the answers to the following questions should be yes. (1) Was conviction for a felony offense? (2) Was the felony conviction for a non-violent offense? (3) Has it been at least 5 years since completion of the felony sentence (including probation, parole, and court-imposed fees)? (4) Has the person demonstrated civic responsibility through community or comparable service? (5) Have there been no other subsequent criminal convictions for felony of misdemeanor offenses (excluding traffic violations) in the last five years? Note: Even if petition is approved by court, the Governor still has discretion to reject application. (1) Was conviction for a felony offense? Voting rights are only taken away for felony convictions. Misdemeanor offenses do not strip you of your civil rights. If you were convicted of a felony offense, go to question 2. If no, you still have your civil rights. Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C, in the back of this guide. If you are still are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted. If you were not convicted by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently reside. We have provided a list of Clerks in Appendix E. (2) Was conviction for a non-violent offense? People with felony convictions for violent, certain drug and/or election-related offenses, as defined by Virginia law, CANNOT petition the court. To learn whether your conviction is eligible for petition restoration, please see Appendix C. If yes, (your conviction was for a non-violent offense), go to question 3. If no, you cannot submit a petition. But you may still apply directly to the Governor. Please see Part 3 on page 6. Note: Remember that violent, certain drug, and election-related offenses are defined differently for the petitioning process than for the application process. Please see Appendix D for a complete list. (3) Did you complete your felony sentence (including probation, parole or paid cost-imposed fees) at least five years ago? If yes, go to question 4. If no, then the court will most likely reject the petition. But you may still apply directly to the Governor. Please see Part 3 (page 6).

(4) Have you demonstrated civic responsibility through community or comparable service? This question requires the court to make its own judgment about whether you have shown civic responsibility. If you believe that you have contributed to your community and can show this, go to question 5. If you have not, then the court will most likely reject the petition. Ultimately, you should make your own decision about whether to still file a petition. Also remember that you can always submit an application to the Governor. Please see Part 3 (page 6). (5) Have you been convicted of a criminal offense (excluding traffic violations) in the past five years? If no, then you are likely to have a successful Circuit Court petition. If yes then the court will most likely reject the petition. Ultimately, you should make your own decision about whether to still file a petition. Also remember that you can always submit an application to the Governor. Please see Part 3 (page 6). Please see Appendix E for a list of Virginia Circuit Courts. Detailed instructions on how to petition a Circuit Court are in Appendix F.

ADVANCEMENT PROJECT VIRGINIA CIVIL RIGHTS RESTORATION GUIDE APPENDICES 1. Appendix A: Non-Violent Offenses: Instructions and Application 2. Appendix B: Violent, Certain Drug, or Election-Related Offenses: Instructions and Application 3. Appendix C: Secretary of the Commonwealth List of Non-Violent and Violent Offenses for the Application Process 4. Appendix D: List of Violent, Certain Drug, and Election-Related Offenses By Virginia Code (Disqualify from Use of Virginia Courts to Petition) 5. Appendix E: Virginia Circuit Court Contact Information 6. Appendix F: Circuit Court Petition Filing Steps 7. Appendix G: Notary Public Information 8. Appendix H: Department of Motor Vehicle Instructions on Obtaining Identification (Non-Driver s License ID) 9. Appendix I: Instructions for Requesting A Copy of Your Birth Certificate/ Individuals Who Need to Correct Their Gender on a Birth Certificate

Restoration of Civil Rights Nonviolent Offenders Application VIRGINIA RESTORATION OF CIVIL RIGHTS APPLICATION FORM Use this form to apply for restoration of civil rights. To apply for restoration of civil rights, you must: Be a resident of Virginia, and/or have been convicted of a felony in a Virginia court, a U.S. District Court, or a military court Have paid all costs, fines, and/or restitution associated with your convictions. Complete a two (2) year waiting period after completion of sentence and/or release from supervised probation or parole Not have any misdemeanor and/or pending criminal charges (excluding traffic convictions) within the past two (2) years immediately preceding the application Not have a conviction for DWI within the past five (5) years immediately preceding the application Persons who have been convicted of a violent offense, a drug manufacturing or distribution offense, crimes involving children, or an election law offense are not eligible for this process using this form. Call (804) 7862441 or go online to www.commonwealth.virginia.gov to get the appropriate form. The Secretary of the Commonwealth will conduct a criminal history and DMV check on all applicants. The civil rights restored through this process include the rights to: Register to vote Hold public office Serve on a jury Serve as a notary public The restoration of rights does not restore the right to possess a firearm. You must petition the appropriate circuit court pursuant to Va. Code 18.2308.2. It also does not expunge a criminal charge, which can only be done by petitioning a circuit court pursuant to Va. Code 19.2392.1 and 19.2392.2. This is not a pardon. A person who has been convicted of a felony must first have his or her rights restored in order to be considered for a simple pardon. Applicants residing outside the Commonwealth of Virginia must include a certified copy of their Driving and Criminal Record from the state they reside. In an effort to significantly expedite the decision making process, if you have a certified copy of the felony sentencing order and proof of payment of court ordered costs, fines and/or restitution, you may include that with the application. If not included, the Office of the Secretary of the Commonwealth will request such copies from the appropriate court. The Secretary of the Commonwealth will also request the required information from the petitioner s probation officer, if applicable. The application will not be considered to be complete until the Secretary of the Commonwealth receives such information. If there is any additional information you would like to provide the Governor for consideration of your request, please feel free to do so. The Governor has the sole discretion to restore a person s civil rights under the Virginia Constitution. There is no process for appealing his decision. A person who has been denied may reapply after one year. The goal of the Administration is to have all decisions made within 60 days of the receipt of a complete and eligible application, with written notice given to the applicant. If you have any questions, please call (804) 7862441 or write to the address provided.

Mail to: Restoration of Rights, Secretary of the Commonwealth, P.O. Box 2454, Richmond, VA 23218 Application for Restoration of Rights for Certain Nonviolent Offenders Legal Name Now Used (Please Print): Male Female Name as Convicted (Please Print): Date of Birth: Social Security Number: Street Address: City, State and Zip Mailing Address (if different from above): Home Phone: Work Phone: Cell Phone: Email (if available): Please indicate above by checking the appropriate box (check all that apply) the number where you may be reached should we need additional information. Felony Offense(s) for Which you seek Restoration of Rights: Please provide a brief description of community or comparable service or any other information you would like the Governor to know (optional): Court in Which Convicted: County/State: community or comparable service: Date(s) of Sentence (MM/DD/YYYY): Date of Release from Supervised Probation, if any (MM/DD/YYYY): Instructions: This affidavit must be signed in the presence of a notary public or other official empowered to administer an oath. AFFIDAVIT I, the undersigned, do solemnly swear (or affirm) that the information on this application, including all attachments, is complete, accurate, and true. Signature of Applicant Commonwealth of Virginia City/County of Subscribed and sworn before me this day of year. Notary Public My Commission Expires:

Restoration of Civil Rights Five Year Application Instructions PLEASE READ CAREFULLY: Persons who have been convicted of a violent offense, a drug manufacturing or distribution offense, an offense against a minor, or an election law offense must use this form to apply for restoration of rights. Current policy states that in order to be eligible for the restoration of rights by Governor Robert F. McDonnell, an applicant must be free from supervised probation and not have any convictions or charges pending for a period of five (5) years immediately preceding the application. No application is considered if there is a charge pending or a conviction for Driving While Intoxicated for a period of five (5) years immediately preceding the application. To apply for restoration of rights, you must: Be a resident of Virginia, and/or have been convicted of a felony in a Virginia court, a U.S. District Court, or a military court Have paid all costs, fines, and/or restitution associated with your convictions Not have a misdemeanor or pending conviction within the five (5) years immediately preceding the application. The Secretary of the Commonwealth will conduct a criminal history and DMV check on all applicants. The civil rights restored through this process include the rights to: Register to vote Hold public office Serve on a jury Serve as a notary public. The restoration of rights does not restore the right to possess a firearm. You must petition the appropriate Circuit Court pursuant to Va. Code 18.2-308.2. It also does not expunge a criminal charge, which can only be done by petitioning a Circuit Court pursuant to Va. Code 19.2-392.1 and 19.2-392.2. This is not a pardon. A person who has been convicted of a felony must first have his or her rights restored in order to be considered for a simple pardon. Applicants residing outside the Commonwealth of Virginia must include certified copies of their Driving Record and Criminal Record from the state they reside. The Governor has sole discretion to restore civil rights. There is no process for appealing his decision. A person who has been denied may reapply after one year from his or her denial date.

This packet contains the necessary forms to petition the Governor for the restoration of your rights. Please read all information and instructions carefully. If you think you are eligible to have your rights restored, complete all the forms, assemble the documents, and return them to this office. There are no costs or fees required of you as a petitioner. If you have questions about your eligibility, contact: Restoration of Rights Secretary of the Commonwealth P. O. Box 2454 Richmond, VA 23218 Phone: (804) 786-2441 THE SECRETARY OF THE COMMONWEALTH WILL NOT ACCEPT INCOMPLETE APPLICATIONS QUESTIONS AND ANSWERS ABOUT RESTORATION OF CIVIL RIGHTS HOW DO I KNOW IF I HAVE LOST MY CIVIL RIGHTS? You have lost your civil rights if you have ever been convicted of a felony in: Any Virginia court; Any court of any other state or the District of Columbia; Any federal court; Any court of an associated commonwealth, territory, or possession of the United States. You have not lost your civil rights if you have only been convicted of a misdemeanor or misdemeanors. HOW DO I KNOW IF A CONVICTON WAS A FELONY? Request a copy of your sentencing order from the Clerk of the Circuit Court in which you were convicted. The sentencing order will state the charge for which you were convicted, the sentencing date, and the original sentence information. HOW DO I KNOW IF I AM ELIGIBLE TO HAVE MY RIGHTS RESTORED? You are eligible if you: Have completed all prison or jail terms; Are not presently under probation or parole supervision; Have no pending charges in any locality; Have paid all fines, restitution, and/or court costs associated with convictions Have been free of any parole or supervised probation for the last five years, and Have not had any misdemeanors or pending convictions in the last five years.

If you do not know the status of fines, restitution, and/or court costs, you will need to consult the Clerk of the Court in which you were convicted. WHAT IF I STILL OWE COURT COSTS? If you are still under an order to pay court costs, fines, and/or restitution as a condition of your sentence, you may not have your rights restored. You must show proof of payment of all court costs, fines, or restitution before being eligible to apply for restoration of your civil rights. WHAT IS THE DIFFERENCE BETWEEN A RESTORATION OF RIGHTS AND A PARDON? Restoration of civil rights, if granted, will fully restore citizenship. It removes all civil disabilities and disqualifications imposed as a result of a felony conviction. These rights include the right to vote, to run for and hold public office, to serve on juries, and to serve as a Notary Public. A restoration of rights may allow you to apply for a pardon. A pardon is an act of official forgiveness and is granted only in exceptional cases. It often serves as a means for the petitioner to advance in employment, education, and self-esteem. WILL THE RESTORATION OF MY CIVIL RIGHTS RESTORE MY RIGHTS TO POSSESS OR TRANSPORT ANY FIREARM OR TO CARRY A CONCEALED WEAPON? No. A person convicted of a felony under the laws of Virginia, or any other state or under federal law may not possess or transport any firearm or carry a concealed weapon (defined to include both handguns and long guns). To regain state firearms privileges, a convicted felon may apply to the Circuit Court of his residence for a permit to possess or carry a firearm. The court in its discretion and for good cause shown may grant the petition. If your conviction, however, was for a federal offense, you may only seek restoration of your firearms privileges through the federal system. While the Governor has the authority to restore state firearms privileges expressly by a pardon or though restoration of political rights, he does not customarily do so. INSTRUCTIONS APPLICATION for RESTORATION of CIVIL RIGHTS Item A: Print your full name, as you are now known. If you have ever changed your name, see instructions for Item B. Item B: If you have ever had your name legally changed since the time of a prior conviction, print the name under which you were convicted. Also, if you were ever convicted under an alias, print the alias name on this line. Item C: Print your date of birth and Social Security Number.

Item D: If you were an inmate in the Virginia Department of Corrections, print your prison number (if known) on this line. If you were an inmate in any other system, print the name of the state or other authority beside the number. Item E: Print your present home address street number or post office box. Item F: Print the city and state where you reside. Item G: Print your mailing address if different from above. Item H: Print your present home and work telephone numbers, including the area codes. Item I: Print your present cell phone number and email address if you wish to include either or both. Item J: Print your present employer s name. Item K: Print your present employer s address. Obtain a letter from your most recent Probation or Parole officer outlining your period of supervision. This letter should be addressed to the Governor, c/o Secretary of the Commonwealth, and may be mailed with your application or mailed directly from the Probation/Parole office. If your officer has retired or is no longer working in that office, call the Probation/Parole office that you reported to and explain to them that you are applying to have your rights restored. They will know what type of letter to provide. Request a copy of your Pre-sentence Report, if applicable, from your supervising Probation or Parole officer/office. The Probation or Parole officer/office will send this directly to the Secretary of the Commonwealth s Office. You will not receive a copy of this report. If there is no Pre-sentence Report available, or one was not ordered by the court to be prepared for sentencing, you must obtain a letter on the Probation/Parole office letterhead indicating it is not available or was not ordered by the court. It is very important that you list each felony conviction on the application. If you do not have this information, you may obtain it from your Probation and Parole Officer, the Clerk of the Court in which you were convicted or through requesting a copy of your criminal record. If you cannot list all convictions on the application, put the remainder on a separate sheet of paper and attach this to the application. You must attach certified copies of every sentencing order for each felony conviction on your record. These may be obtained from the Clerk of the Court in which you were convicted. NOTE: Your order of conviction and sentencing order may be the same document. If you have ever had a sentence terminated by any court, or if you have ever had your probation or parole terminated, you should obtain and attach certified copies of any court order or other official document modifying that term.

LETTER OF PETITION Read and sign the letter of petition. Be sure to put the date on the proper line. LETTERS OF REFERENCE Take the three (3) letters of reference to three (3) reputable people who live in your home community. Be certain these are people who know you well enough to certify your good character. Good people to ask for references might be: Your employer or job supervisor; A local businesswoman or businessman; Your minister, priest, rabbi, or other spiritual advisor; A leader of a local civic group; A state or local public official; or A law enforcement officer. Have each person answer the questions in the letter and sign and date it at the bottom. Ask each person to return the letter to you. You must return the three (3) letters with your application. NOTE: Family members or in-laws may NOT sign these letters of reference. It is not necessary to explain the purpose of the letter of reference to the people who sign it, but they may wish to know. The decision to tell them is up to you. LETTER TO THE GOVERNOR Please provide the Governor with a letter describing the circumstances of your offense, community or comparable service and any other information you may want the Governor to know when reviewing your petition. This letter may be prepared by a family member, friend, attorney, or civil organization representative and signed by you. APPLICANTS PETITIONING OUTSIDE OF THE COMMONWEALTH OF VIRGINIA Please provide the Governor with the following documents: A certified copy of your Driving Record from the state in which you reside A certified copy of your Criminal Record from the state in which you reside If a conducted search has returned NO record of a criminal history, please submit certified documentation stating such.

Mail your application to: Restoration of Rights Secretary of the Commonwealth P. O. Box 2454 Richmond, VA 23218 Make certain you have included the following: The application, completely filled out, signed and notarized Certified copies of all felony sentencing orders Certified proof of payment for any fines, restitution and/or court costs The letter of petition, signed and dated Three letters of reference, completed, signed and dated by three (3) reputable citizens A current letter from your most recent Probation or Parole officer/office, addressed to the Governor, outlining your period of supervision A letter to the Governor describing the circumstances of your offense, community or comparable service and any additional information you may want the Governor to know when reviewing your petition If you are an applicant living outside the Commonwealth of Virginia, attach certified copies of your Driving Record and Criminal Record from the state you reside. If applicable, please be sure to request your Pre-sentence Report from your Probation or Parole officer/office. They will send this directly to the Secretary of the Commonwealth s Office.

Restoration of Rights Violent Offenders / Drug Offenders / Election Law Offenders Application Before filling out this application, be sure to read the instructions thoroughly and print or type the complete information in each blank. If a question does not apply, put N/A in the blank. Attach certified copies of all required documents to this application. The affidavit on the reverse side must be signed in the presence of a notary public or other official empowered to administer oaths. A. Legal Name Now Used (Please Print): B. Name as Convicted (Please Print): C. Date of Birth: Social Security Number: D. Prison Number (If any): E. Home Address: F. City and State: G. Mailing Address: H. Home Phone: Work Phone: K. Cell Phone: Email (If any): J. Present Employer: K. Employer s Address: Felony Offense(s): Court: County/State: Date(s) of Conviction: Date(s) of Sentence: Date of Release from Date of Release from Incarceration (If Applicable): Supervised Probation or Parole: If necessary, you may use the space below to include additional information.

1. If you were on supervised probation or parole: Obtain a letter from the District Probation/Parole office outlining your period of supervision or parole. IF a Pre-sentence Report was prepared, request that the Probation/Parole office forward this report to: Restoration of Rights, Secretary of the Commonwealth P.O. Box 2454, Richmond, VA 23218. Please Note: The Pre-sentence Report will not be directly given to the applicant but mailed upon your request to the Secretary of the Commonwealth s Office. 2. Attach a certified copy of the sentencing order for each felony conviction. 3. Attach a certified copy of each order that modifies or changes the sentencing order for each felony conviction, if applicable. This includes any order reducing or terminating any sentence, suspended sentence, or any term of probation. 4. Attach certified receipt (s) of proof of payment of any fines, court costs, or restitution. 5. Attach a letter addressed to the Governor describing the circumstances of your offense, community or comparable service and any other information you may want the Governor to know when reviewing your petition. 6. Have you ever had your rights restored for any criminal conviction in Virginia or any other state? YES NO (If you have checked YES, please attach document) 7. Have you ever had been granted a pardon for any criminal conviction in Virginia or any other state? YES NO (If you have checked YES, please attach document) 8. Have you completed all prison/jail terms, probation or parole, and/or supervised release for a minimum of five (5) years? YES NO (If the answer is NO, you may not be eligible for this process at this time) Instructions: This affidavit must be signed in the presence of a notary public or other official empowered to administer an oath. AFFIDAVIT I, the undersigned, do solemnly swear (or affirm) that the information on this application, including all attachments, is complete, accurate, and true. Signature of Applicant Commonwealth of Virginia City/County of Subscribed and sworn before me this day of year. Notary Public My Commission Expires: Mail this application and all required documentation to: Restoration of Rights Secretary of the Commonwealth P.O. Box 2454, Richmond, VA 23218

Governor of Virginia c/o Secretary of the Commonwealth Post Office Box 2454 Richmond, VA 23218 LETTER OF PETITION Date: Dear Governor: I am enclosing my application for the restoration of my civil rights. I believe that the information contained herein is complete and accurate. I understand that an incomplete or ineligible application will not be accepted and may be returned to me. I have attached certified copies of all orders of conviction and/or sentencing pertaining to my felony conviction(s), as well as all other required documents. In addition, I am submitting three letters of reference from reputable citizens who can attest to my character and reputation in the community. I believe that my application will prove that I have earned the privilege to have my civil rights restored. I understand that the decision to restore my rights is vested solely in the office of the Governor of Virginia. Thank you for your consideration. Respectfully yours, Signature Address City, State, Zipcode

Letter of Reference Print Name Occupation or Title Address City, State, Zip code Governor of Virginia c/o Secretary of the Commonwealth Post Office Box 2454 Richmond, VA 23218 Dear Governor: I am writing at the request of whom I have known personally for years. I am not a relative by birth or by marriage, and I believe that he/she is a law abiding citizen of good character. My relationship with the applicant is, and I am enclosing additional comments below: I hope this information will be helpful to you. Respectfully, Signature of Reference

Letter of Reference Print Name Occupation or Title Address City, State, Zip code Governor of Virginia c/o Secretary of the Commonwealth Post Office Box 2454 Richmond, VA 23218 Dear Governor: I am writing at the request of whom I have known personally for years. I am not a relative by birth or by marriage, and I believe that he/she is a law abiding citizen of good character. My relationship with the applicant is, and I am enclosing additional comments below: I hope this information will be helpful to you. Respectfully, Signature of Reference

Letter of Reference Print Name Occupation or Title Address City, State, Zip code Governor of Virginia c/o Secretary of the Commonwealth Post Office Box 2454 Richmond, VA 23218 Dear Governor: I am writing at the request of whom I have known personally for years. I am not a relative by birth or by marriage, and I believe that he/she is a law abiding citizen of good character. My relationship with the applicant is, and I am enclosing additional comments below: I hope this information will be helpful to you. Respectfully, Signature of Reference

APPENDIX C Secretary of the Commonwealth List of Non-Violent and Violent Offenses for the Application Process Source: http://www.commonwealth.virginia.gov/judicialsystem/clemency/restoration.cfm Felony convictions for which an applicant must complete the 2-Year Application: Embezzlement Welfare Fraud Habitual Offender Grand Larceny Drug Possession (must not be Drug Possession with the Intent to Distribute) Breaking and Entering Burglary/Statutory Burglary/Possession of Burglarious Tools Obtain Money by False Pretenses Prescription Fraud/Obtain Drugs by Fraud Petit Larceny, 3rd or Subsequent Offense Felonious Shoplifting/Concealment/Price Altering Driving Under the Influence or Driving While Intoxicated, 3rd or Subsequent Offense Credit Card Theft/Credit Card Fraud/Credit Card Forgery Identity Theft Mail Theft/Mail Fraud Bank Fraud Issuing Bad Checks/Worthless Checks Felony Eluding Police Forgery Uttering Perjury False Statement on Firearm Transaction Record Unlawful Possession of a Concealed Weapon Felony convictions for which an applicant must complete the 5-Year Application: Drug Possession with the Intent to Distribute Drug Distribution Drug Manufacturing Robbery Malicious/Unlawful Wounding Felonious Assault Maiming Murder Manslaughter Involuntary or Voluntary Production, publication, sale, financing, etc., of child pornography Shooting into an Occupied Vehicle or Building Arson of an Occupied Vehicle or Building Hit & Run/Leaving the Scene of an Accident with Injury Election Fraud Rape Forcible Sodomy/Sodomy of a Minor Carnal Knowledge of a Minor Carnal Knowledge of an Inmate by Correctional or Law Enforcement Officer Breaking and Entering with Intent to Commit Rape or Assault Accommodation Sale of a Controlled Substance Child Abuse/Neglect

APPENDIX D Offenses Preventing the Use of Virginia Courts to Restore Voting Rights ( Violent Crimes) Offense VA Code Provision First and second degree murder and voluntary manslaughter 18.2-30, et seq. Mob-related felonies 18.2-38, et seq. Kidnapping or abduction felonies 18.2-47, et seq. Malicious felonious assault or malicious bodily wounding 18.2-51, et seq. Felony criminal sexual assault 18.2-61, et seq. Arson when structure occupied 18.2-77, 18.2-79 Capital murder 18.2-31 First and second degree murder 18.2-32 Felony homicide 18.2-33 Voluntary manslaughter 18.2-35 Aggravated involuntary manslaughter 18.2-36.1(B) Mob lynching 18.2-40 Mob shooting, stabbing, etc., with intent to kill 18.2-41 Shooting, stabbing, etc., with intent to kill 18.2-51 Malicious bodily injury to law enforcement officers 18.2-51.1 Aggravated malicious wounding 18.2-51.2 Reckless endangerment of other by throwing objects from high places 18.2-51.3 Malicious bodily injury by caustic substance or explosive 18.2-52 Possession of infectious biological substances 18.2-52.1 Shooting, etc. in committing or attempting a felony 18.2-53 Use or display of firearm in committing a felony 18.2-53.1 Attempts to poison 18.2-54.1 Adulteration of food, drink, drugs, cosmetics, etc. 18.2-54.2 Bodily injury caused by prisoners, probationers, or parolees 18.2-55 Felony assault and battery against a family or household member 18.2-57.2 Felony threatening the Governor or his family 18.2-60.1 Felony stalking 18.2-60.3 Rape 18.2-61 Carnal knowledge of certain minors 18.2-64.1 Forcible sodomy 18.2-67.1 Object sexual penetration 18.2-67.2 Marital sexual assault 18.2-67.2:1 Aggravated sexual battery 18.2-67.3 Attempted rape, forcible sodomy, object sexual penetration, aggravated sexual 18.2-67.5 battery, and sexual battery Third misdemeanor conviction of sexual battery or attempted sexual battery 18.2-67.5:1 Class 4 felony Carnal knowledge of childe between 13 and 15 years of age 18.2-63 Burning or destroying dwelling house, etc., if occupied 18.2-77(A) Class 3 felony burning or destroying meeting house 18.2-79 Class 3 felony burning or destroying any other structure 18.2-80 Burglary 18.2-89 Entering dwelling house, etc. with intent to commit murder, rape, or robbery 18.2-90 Entering dwelling house, etc. with intent to commit larceny, assault and battery, or 18.2-91 other felony Breaking and entering dwelling house with intent to commit other misdemeanor 18.2-92 Entering bank, armed, with intent to commit larceny 18.2-93 Felony personal trespass by computer 18.2-152.7

Class 4 felony obstructing or injuring canal, railroad, power line, etc. 18.2-153 Class 4 felony shooting at or throwing missiles, etc. at train, car, vessel, etc. 18.2-154 Class 4 felony injuring, etc., signal used by railroad 18.2-155 Felony damage or trespass to public services or utilities 18.2-162 Discharging firearms or missiles within or at occupied building or dwelling house 18.2-279 Willfully discharging firearms in public places, at or near a school 18.2-280 Setting spring gun or other deadly weapon 18.2-281 Shooting from vehicle so as to endanger persons 18.2-286.1 Use of machine gun for crime of violence 18.2-289 Use of machine gun for aggressive purpose 18.2-290 Felony pointing holding or brandishing firearm of object similar in appearance so 18.2-282 as to induce fear in the mind of another of being shot Possession or use of sawed-off shotgun in commission of crime of violence 18.2-300 Felony possession of firearm, stun weapon, or other weapon on school property 18.2-308.1 Felony possession or transportation of firearms or concealed weapons by convicted 18.2-308.2 felons Violations of prohibitions on selling firearms to certain persons 18.2-308.2:1 Purchase of a firearm with intent to resell to certain persons; or solicitation, by a 18.2-308.2:2 person ineligible to purchase a firearm, of another to purchase a firearm on his or her behalf Use or attempted use of restricted ammunition in commission or attempted 18.2-308.3 commission of crimes Illegal use of tear gas, phosgene and other gases 18.2-312 Taking, detaining, etc. a person against their will for prostitution etc.; consenting as 18.2-355 a parent or guardian to the taking, detaining, etc. of a person for prostitution, etc. Detaining male or female in bawdy place against his or her will 18.2-358 Sodomy with an immediate relative 18.2-361 Fornication with an immediate relative 18.2-366 Placing or leaving wife for prostitution 18.2-368 Taking indecent liberties with children 18.2-370 Taking indecent liberties with child by person in custodial or supervisory 18.2-370.1 relationship Willful abuse and neglect of children causing serious injury to life or health 18.2-371.1(A) Felony abuse and neglect of incapacitated adults, resulting in serious bodily injury 18.2-369 or disease Production, publication, sale, possession with intent to distribute, financing, etc., of 18.2-374.1 sexually explicit items involving children Felony possession of child pornography 18.2-374.1:1 Use of electronic means to facilitate certain offenses involving children 18.2-374.3 Any second or subsequent offense for employing or permitting a minor to assist in 18.2-379 any obscenity related offense Felony rioting 18.2-405 Felony unlawful assembly 18.2-406 Conspiracy to incite, etc., a riot 18.2-408 Commission of certain offenses in county, city, or town declared by Governor to 18.2-413 be in state of riot or insurrection Injury to property or persons by persons unlawfully or riotously assembled 18.2-414 Paramilitary activity 18.2-433.2 Felony obstruction of justice 18.2-460 Felony delivery of drugs, firearms, explosives, etc. to prisoners 18.2-474.1 Felony escapes from juvenile facility 18.2-477.1

Prisoner escaping from jail 18.2-477 Escape from jail or custody by force or violence without setting fire to jail 18.2-478 Escape without force or violence or setting fire to jail 18.2-479 Escape, etc., by setting fire to jail 18.2-480 Conspiring to incite one race to insurrection against another race 18.2-485 Felonies by prisoners 53.1-203 Felony manufacturing, selling, giving, distributing or possessing with intent to 18.2-248 manufacture, sell, give or distribute a controlled substance or an imitation controlled substance Felony transporting controlled substances into Virginia 18.2-248.01 Felony sale, gift, distribution, or possession with intent to sell, give or distribute 18.2-248.1 marijuana Felony distribution of certain drugs to persons under 18 18.2-255 Felony sale of drugs on or near certain properties 18.2-255.2 Felony maintaining a fortified drug house 18.2-258.02 Felony making of false statement in connection with election forms, etc. 24.2-1016

APPENDIX E Circuit Courts of Virginia 1 County/City Clerk Address Phone Accomack Samuel H. Cooper Jr. P.O. Box 126 Tel: 757/787-5776 SHCooper@courts.state.va.us Courthouse Road Accomack, VA 23301-0126 Fax: 757/787-1849 Albemarle Hon. Debra Shipp Albemarle County Courthouse Alexandria Allegheny Amelia Edward Semonian Jr. ed.semonian@alexandriava.gov Hon. Debra Byer dbyer@courts.state.va.us Hon. Marilyn Wilson mwilson@courts.state.va.us Court Square 501 East Jefferson Street Charlottesville, VA 22902 Courthouse 520 King Street Alexandria, VA 22314 Alleghany County P.O. Box 670 Courthouse 266 W. Main Street Covington, VA 24426-0670 P. O. Box 237 Courthouse Square Amelia, VA 23002-0237 Amherst Hon. Roy C. Mayo III P. O. Box 462 113 Taylor Street Amherst, VA 24521 Appomattox Hon. Janet A. Robertson jrobertson@courts.state.va.us Tel: 434/972-4083 434/972-4085 Fax: 434/293-0298 Tel: 703/746-4044 Fax: Tel: (540) 965-1730 Fax: Tel: 804/561-2128 Fax: 804/561-6364 Tel: 434/946-9321 Fax: 434/946-9323 297 Court Street, Suite B Tel: 434/352-5275 P.O. box 672 Fax: 434/352-2781 Appomattox, VA 24522-0672 Arlington Augusta Bath Bedford Hon. Paul F. Ferguson circuitcourt@arlingtonva.us Hon. John B. Davis jbdavis@courts.state.va.us Hon. M. Wayne Winebriner wwinebriner@courts.state.va.us Hon. Cathy C. Hogan chogan@courts.state.va.us 1425 N. Courthouse Road, Sixth Floor, Suite 6700 Arlington, VA 22201 P. O. Box 689 Augusta County Courthouse 1 East Johnson Street Staunton, VA 24402-0689 P. O. Box 180 Courthouse Warm Springs, VA 24484-0180 123 East Main St. Suite 201 Bedford, VA 24523 Tel: 703-228-7010 (Civil) Fax: Tel: 540/245-5321 Fax: 540/245-5318 Tel: 540/839-7226 Fax: 540/839-7248 Tel: 540/586-7632 Fax: 540/586-6197 Bland Hon. Rebecca I. Johnson rijohnson@courts.state.va.us Judges' Address: 123 East Main St., Suite 301 612 Main Street, Suite 104 P. O. Box 295 Tel: 276/688-4562 Fax: 276/688-2438 1 Information obtained from www.courts.state.va.us/courts/courts.html.

Bland, VA 24315-0295 Botetourt Hon. Tommy L. Moore P. O. Box 219 Courthouse Main Street Fincastle, VA 24090-0219 Bristol Brunswick Hon. Terry G. Rohr TRohr@courts.state.va.us Hon. V. Earl Stanley Jr. vesjr@telpage.net Courthouse 497 Cumberland Street Bristol, VA 24201 216 North Main Street Lawrenceville, VA 23868-0160 Buchanan Hon. Beverly S. Tiller P. O. Box 929 Courthouse Grundy, VA 24614 Tel: 540/473-8274 Fax: 540/473-8209 Tel: 276/645-7321 Fax: 276/821-6097 Tel: 434/848-2215 Fax: 434/848-4307 Tel: 276/935-6567 Fax: Buckingham Hon. Malcolm Booker Jr. 13061 W. James Anderson Tel: 434/969-4734 Hwy P. O. Box 107 Fax: 434/969-2043 Buckingham, VA 23921-0107 Buena Vista Hon. Christopher W. Coleman ccoleman@courts.state.va.us Municipal Building 2039 Sycamore Avenue Buena Vista, VA 24416 Campbell Hon. Sheila Bosiger P. O. Box 7 732 Village Highway Rustburg, VA 24588-0007 Caroline Hon. Ray S. Campbell Jr. P. O. Box 309 112 Courthouse Lane, Suite A Tel: 540/261-8627 Ext. 127 Fax: 540/261-8625 Tel: 434/592-9517 Fax: Tel: 804/633-5800 Fax: Carroll Hon. Carolyn H. Honeycutt CHoneycutt@courts.state.va.us Bowling Green, VA 22427-0309 P. O. Box 218 605 Pine Street Hillsville, VA 24343-0218 Tel: 276/730-3070 Fax: 276/730-3071 Charles City Hon. Edith K. Holmes ekholmes@courts.state.va.us P. O. Box 86 10780 Courthouse Road Charles City, VA 23030-0086 Tel: 804/652-2105 804/652-2107 Fax: 804/829-5647 Charlotte Hon. Stuart B. Fallen SFallen@courts.state.va.us 125 David Bruce Ave P. O. Box 38 Charlotte Courthouse, VA 23923-0038 Charlottesville Hon. Paul C. Garrett 315 East High Street Charlottesville, VA 22901 Chesapeake Hon. Faye W. Mitchell General District and Circuit fmitchell@courts.state.va.us Court Building 307 Albemarle Dr., Suite 300A; Judges: Suite 400A Tel: 434/542-5147 Fax: 434/542-4336 Tel: 434/970-3766 Fax: Tel: 757/382-3000 Fax: 757/382-3034 Fax Criminal and Civil: 757/382-3035

Chesterfield Chesapeake, VA 2 3322-5579 Judges Chambers: 757/382-3050 Hon. Judy L. Worthington P. O. Box 125 Tel: 804/748-1241 circuitcourtclerk@chesterfield.gov 9500 Courthouse Road Fax: 804/796-5625 Chesterfield, VA 23832-0125 P.O. Box 57 (Judges) Clarke Hon. Helen Butts P. O. Box 189 hbutts@courts.state.va.us 102 N. Church Street Berryville, VA 22611-0189 Colonial Heights Hon. Stacy L. Stafford 401 Temple Ave SStafford@courts.state.va.us P.O. Box 3401 Colonial Heights, VA 23834 Craig Hon. Sharon P. Oliver 182 Main Street, Suite 4 P. O. Box 185 New Castle, VA 24127-0185 Tel: 540/955-5116 Fax: 540/955-0284 Tel: 804/520-9364 Fax: Tel: 540/864-6141 Fax: 540/864-7471 Culpeper Hon. Janice J. Corbin Courthouse Bldg 135 W. Cameron Street Culpeper, VA 22701-3097 Cumberland Hon. Carol Ownby COwnby@courts.state.va.us P. O. Box 8 Cumberland, VA 23040-0008 Danville Hon. Gerald A. Gibson P. O. Box 3300 Courts and Jail Building 401 Patton Street Danville, VA 24543 Dickenson Hon. Richard W. Edwards Box 190 293 Main Street Clintwood, VA 24228-0190 Dinwiddie Hon. John B. Chappell Jr. P. O. Box 63 bchappell@courts.state.va.us Dinwiddie, VA 23841-0063 Essex Hon. Gayle Ashworth gashworth@courts.state.va.us P. O. Box 445 305 Prince Street Tappahannock, VA 22560 Fairfax Hon. John T. Frey Jennings Building Judicial Center 4110 Chain Bridge Road Fairfax, VA 22030 Fauquier Gail H. Barb 29 Ashby St. clerk@fauquiercounty.gov Warrenton, VA. 20186 Floyd Hon. Wendell G. Peters 100 E. Main Street Room 200 Floyd, VA 24091 Fluvanna Hon. Bouson E. Peterson Jr. BPeterson@courts.state.va.us 72 Main St. P. O. Box 550 Palmyra, VA 22963 Tel: 540/727-3438 Fax: 540/727-3475 Tel: 804/492-4442 Fax: 804/492-4876 Tel: (434) 799-5168 Fax: (434) 799-6502 Tel: 276/926-1616 Fax: 276/926-6465 Tel: 804/469-4540 Fax: Tel: 804/443-3541 804/443-4381 Tel: 703/246-4111 Fax: 703/691-7320 Tel: 540/347-8610 Fax: 540/347-0512 Tel: 540/745-9330 Fax: 540/745-9303 Tel: 434/591-1970 Fax: 434/591-1971 Franklin Hon. Teresa J. Brown P.O. Box 567 Tel: 540/483-3065

tjbrown@courts.state.va.us 275 South Main Street Suite 212 Rocky Mount, VA 24151 Fax: 540/483-3042 Frederick Fredericksburg Giles Hon. Rebecca P. Hogan rhogan@courts.state.va.us Hon. Sharron S. Mitchell smitchell@courts.state.va.us Hon. Charles L. Fraley III cfraley@courts.state.va.us P.O. Box 601 (Judge) 5 North Kent Street Winchester, VA 22601 815 Princess Anne Street P. O. Box 359 Fredericksburg, VA 22404-0359 P. O. Box 502 501 Wenonah Avenue Pearisburg, VA 24134 Gloucester Hon. Margaret F. Walker 7400 Justice Drive Room 327 Glouscester, VA 23061 Goochland Hon. Lee Grubbs Turner P. O. Box 196 2938 River Road West Goochland, VA 23063 Grayson Hon. Susan M. Herrington P. O. Box 130 129 Davis Street Independence, VA 24348-0130 Greene Hon. Marie C. Durrer P. O. Box 386 Standardsville, VA 22973-0386 22 Court Street Greensville Hon. Robert C. Wrenn P. O. Box 631 337 South Main Street Emporia, VA 23847-0631 Halifax Hon. Robert W. Conner P. O. Box 729 Main Street Halifax, VA 24558-0729 Hampton Hon. Linda Batchelor Smith P. O. Box 40 101 King's Way Mall Hampton, VA 23669-0040 Hanover Hon. Frank D. Hargrove Jr. P.O. Box 7507 Library Dr. Hanover, VA 23069 Henrico Hon. Yvonne G. Smith P.O. Box 90775 4301 East Parham Road Henrico, VA 23273-0775 Tel: 540/667-5770 Fax: 540/667-6638 Tel: 540/372-1066 Fax: 540/310-0637 Judges Chambers: 540/372-1171 Judges Chambers Fax: 540/372-1174 Tel: 540/921-1722 Fax: 540/921-3825 Tel: 804/693-2502 Fax: 804/693-2186 Tel: 804/556-5353 Tel: 276/773-2231 Fax: 276/773-3338 Tel: 434/985-5208 Fax: 434/985-6723 Tel: 434/348-4215 Fax: 434/348-4020 Tel: 434/476-6211 Fax: 434/476-2890 Judges Office: 434/476-2890 Judges Fax: 434/476/6076 Tel: 757/727-6105 Fax: 757/728-3505 Tel: 804/365-6150 Fax: 804/365-6278 Tel: 804/501-4202 Henry Hon. Vickie Stone Helmstutler Suite B Tel: 276/634-4880 3160 Kings Mountain Rd. Martinsville, VA 24112-3966

Highland Hon. Lois S. Ralston lralston@courts.state.va.us P. O. Box 190 Monterey, VA 24465-0190 Hopewell Hon. Tamara J. Ward P. O. Box 310 tward@courts.state.va.us 100 E. Broadway Room 251 Hopewell, VA 23860 Isle of Wight Hon. Sharon N. Jones 17000 Josiah Parker Circle P.O. Box 110 Isle of Wight, VA 23397 James City County/ Williamsburg Hon. Betsy B. Woolridge 5201 Monticello Avenue Suite Six Williamsburg, VA 23188-8218 Tel: 540/468-2447 Fax: 540/468-3447 Tel: 804/541-2239 Fax: 804/541-2438 Tel: 757/365-6233 Tel: 757/564-2242 Fax: 757/564-2329 Judges Chambers: 757/564-2300 King and Queen Hon. Deborah F. Longest P. O. Box 67 Tel: 804/785-5984 Court House Fax: 804/785-5698 King And Queen, VA 23085-0067 King George Hon. Charles V. Mason 9483 Kings Highway Suite 3 King George, VA 22485-0105 Tel: 540/775-3322 King William Hon. Patricia M. Norman pnorman@courts.state.va.us 351 Courthouse Lane P. O. Box 216 King William, VA 23086-0216 Lancaster Hon. Diane H. Mumford P. O. Box 99 8265 Mary Ball Road Lancaster, VA 22503 Lee Hon. Beverly R. Anderson banderson@courts.state.va.us P. O. Box 326 Main Street Jonesville, VA 24263-0326 Loudoun Hon. Gary M. Clemens P. O. Box 550 18 E. Market St. Leesburg, VA 20178 Louisa Hon. Susan R. Hopkins Box 37 100 W. Main Street Louisa, VA 23093-0037 Lunenberg Hon. Gordon F. Erby 11435 Courthouse Road Lunenburg, VA 23952 Lynchburg Hon. Eugene C. Wingfield P. O. Box 4 900 Court Street Lynchburg, VA 24505-0004 Madison Linda M. Parrish P. O. Box 220 1 Main Street Madison, VA 22727-0220 Tel: 804/769-4936 804/769-4937 804/769-4938 Fax: 804/769-4991 Tel: 804/462-5611 Fax: 804/462-9978 Tel: 276/346-7763 Fax: 276/346-3440 Tel: 703/777-0270 Fax: 703/777-0376 Tel: 540/967-5312 Fax: 540/967-2705 Tel: 434/696-2132 Fax: 434/696-3931 Tel: 434/455-2620 Fax: 434/847-1864 Tel: 540/948-6888 Fax: 540/948-3759 Martinsville Hon. Ashby R. Pritchett APritchett@courts.state.va.us P. O. Box 1206 Tel: 276/656-5106 55 W. Church Street Fax: 276/656-5232 Martinsville, VA 24114-1206

Mathews Hon E. E. Callis III P. O. Box 463 10622 Buckley Hall Road Mathews, VA 23109 Mecklenburg Hon. E. E. Coleman Jr. 393 Washington Street P. O. Box 530 Boydton, VA 23917-0530 Middlesex Hon. Peggy W. Walton P O Box 158 Routes 17 & 33 Courthouse Saluda, VA 23149 Montgomery Hon. Erica W. Williams 1 E. Main Street, Suite B-5 Christiansburg, VA 24068-6309 Nelson Hon. Judy Stevens Smythers P. O. Box 10 84 Courthouse Square, 1st Floor Lovingston, VA 22949-0010 New Kent Hon. Karen A. Butler P. O. Box 98 Courthouse 12001 Courthouse Circle New Kent, VA 23124-0098 Newport News Hon. Rex A. Davis 2500 Washington Avenue Courthouse Building Newport News, VA 23607 Norfolk Hon. George E. Schaefer 100 St. Paul's Boulevard Norfolk, VA 23510 Northampton Hon. Traci L. Johnson P.O. Box 36 5229 The Hornes Eastville, VA 23347-0036 Northumberland Hon. Linda Booth lbooth@courts.state.va.us P. O. Box 217 39 Judicial Place Heathsville, VA 22473-0217 Nottoway Hon. Jane L. Brown 328 West Courthouse Road Nottoway, VA 23955-0025 Orange Hon. Teresa T. Carroll 110 North Madison Rd Suite 300 P. O. Box 230 Orange, VA 22960 Page Hon. C. R. Wilson 116 South Court Street Suite A Luray, VA 22835 Patrick Hon. Susan C. Gasperini P. O. Box 148 101 Blue Ridge Street Stuart, VA 24171-0148 Petersburg Hon. Benjamin O. Scott 7 Courthouse Avenue BScott@courts.state.va.us Petersburg, VA 23803 Pittsylvania Hon. H. F. Haymore Jr. Drawer 31 3 N. Main Street Chatham, VA 24531 Tel: 804/725-2550 Tel: 434/738-6191 Ext. 298 Fax: 434/738-6861 Tel: 804/758-5317 Fax: 804/758-8637 Tel: 540/382-5760 Fax: 540/382-6937 Tel: 434/263-7020 Fax: 434/263-7027 Tel: 804/966-9520 Fax: 804/966-9528 Tel: 757/926-8561 Fax: 757/926-8531 Tel: 757/664-4580 Tel: 757/678-0465 Fax: 757/678-5410 Tel: 804/580-3700 Fax: 804/580-2261 Tel: 434/645-9043 Fax: 434/645-2201 Tel: 540/672-4030 Fax: 540/672-2939 Tel: 540/743-4064 540/743-6902 Fax: 540/743-2338 Tel: 540/694-7213 Fax: 540/694-6943 Tel: 804/733-2367 Fax: 804/732-5548 Tel: 434/432-7887 Fax: 434/432-7913

Portsmouth Powhatan Prince Edward Hon. Cynthia P. Morrison CMorrison@courts.state.va.us Hon. William E. Maxey Jr. wmaxey@courts.state.va.us hon. Machelle J. Eppes meppes@coruts.state.va.us P. O. Box 1217 601 Crawford Parkway Portsmouth, VA 23705-1217 P. O. Box 37 3880 Old Buckingham Road Suite C Powhatan, VA 23139-0037 Courthouse Building P. O. Box 304 North Main Street Farmville, VA 23901-0304 Prince George Hon. Bishop Knott Jr. P. O. Box 98 6601 Courts Drive Prince George, VA 23875-0098 Judges: P.O. Box 280 Prince William Hon. Michele B. McQuigg mmcquigg@pwcgov.org 9311 Lee Avenue Manassas, VA 20110 Pulaski Hon. Maetta H. Crewe 45 Third Street, NW Suite 101 Pulaski, VA 24301 Radford Hon. Ann Howard 619 Second Street, West ahoward@radford.va.us Radford, VA 24141 Rappanhannock Diane Bruce 238 Gay Street P. O. Box 517 Washington, VA 22747-0517 Tel: 757/393-8671 Tel: 804/598-5660 Fax: 804/598-5608 Tel: 434/392-5145 Fax: 434/392-3913 Tel: 804/733-2640 Fax: 804/861-5721 Court Administrator: 804/733-2623 Tel: 703/792-6015 Criminal Fax: 703/792-4721 Civil Fax: 703/792-7750 Tel: 540/980-7825 Fax: 540/980/7835 Tel: 540/731-3610 Fax: 540/731-3612 Tel : 540/675-5350 Fax: 540/675-5351 Richmond Hon. Bevill M. Dean 400 North Ninth Street Tel: 804/646-6505 John Marshall Courts Building Fax: 804/646-6562 Richmond, VA 23219 Richmond County Hon. Rosa S. Forrester P. O. Box 1000 101 Court Circle Warsaw, VA 22572-0956 Richmond Manchester Bevill M. Dean 10th & Hull Streets Manchester Courthouse Richmond, VA 23224-0129 Roanoke City Hon. Brenda S. Hamilton P.O. Box 2610 circlek@ci.roanoke.va.us 315 Church Avenue, S.W. Roanoke, VA 24016 Roanoke County Hon. Steven A. McGraw, Sr. smcgraw@roanokecountyva.gov 305 East Main Street, Room 200 P. O. Box 1126 Salem, Virginia 24153-1126 Tel: 804/333-3781 Fax: 804/333-5396 Tel: 804/646-8470 Fax: 804/646-8122 Tel: 540/853-6702 Fax: 540/853-1024 Tel: 540/387-6205 Fax: 540/387-6145 Rockbridge Hon. D. Bruce Patterson dbpatterson@courts.state.va.us Rockbridge County Courthouse 20 South Randolph St Suite Tel: 540/463-2232 Fax: 540/463-3850

Rockingham Hon. Chaz W. Evans-Haywood clerkchaz@rockinghamcountyva.g ov 101 Lexington, VA 24450 Rockingham County Courthouse Court Square Harrisonburg, VA 22801 Russell Hon. Ann Sword McReynolds P. O. Box 435 Main Street Lebanon, VA 24266-0435 Salem Hon. Chance Crawford CCrawford@courts.state.va.us 2 East Calhoun Street Salem, VA 24153 Tel: 540/564-3111 Fax: 540/564-3127 Tel: 276/889-8023 Fax: 276/889-8003 Tel: 540/375-3067 Fax: 540/375-4039 Scott Hon. Mark A. (Bo) Taylor 202 West Jackson St Suite102 Tel: 276/386-3801 Gate City, VA 24251 Fax: 276/386-2430 Shenandoah Hon. Denise F. Barb P.O. Box 406 Tel: (540) 459-6150 112 South Main Street Fax: (540) 459-6155 Woodstock, Virginia 22664 Smyth Hon. John H. Graham 109 W. Main Street Room 144 Tel: 276/782-4044 Marion, VA 24354-1025 Fax: 276/782-4045 Southampton Hon. Richard L. Francis rfrancis@courts.state.va P. O. Box 190 22350 Main Street Courtland, VA 23837 Tel: 757/653-2200 Spotsylvania Hon. Christalyn M. Jett P. O. Box 96 Tel: 540/582-7600 9115 Courthouse Road Fax: 540/582-2169 Spotsylvania, VA 22553-0096 Stafford Hon. Barbara G. Decatur P.O. Box 69 Tel: 540-658-8750 BDecatur@courts.state.va.us 1300 Courthouse Road, Fax: Stafford, VA 22555 Staunton Hon. Thomas E. Roberts 113 E. Beverley Street Tel: 540/332-3874 Staunton, VA 24402-1286 Fax: 540/332-3970 Suffolk Hon. W.R. Carter Jr. P. O. Box 1604 Mills E. Godwin, Jr. Courts Bldg. 150 North Main Street Suffolk, VA 23439-1604 Surry Hon. Gail P. Clayton gclayton@courts.state.va.us 28 Colonial Trail East Routes 10 And 31 Surry, VA 23883-0203 Sussex Hon. Gary M. Williams P. O. Box 1337 15088 Courthouse Road Route 735 Sussex, VA 23884 Tazewell Hon. James E. Blevins 101 Main Street bblevins@courts.state.va.us Tazewell, VA 24651-0968 Virginia Beach Hon. Tina E. Sinnen TSinnen@courts.state.va.us 2425 Nimmo Parkway Virginia Beach, VA 23456 Tel: 757/514-7800 Fax: 757/514-7103 Tel: 757/294-3161 Fax: 757/294-0471 Tel: 434/246-5511 434/246-1012 Fax: 434/246-2203 Tel: 276/988-1222 Fax: 276/988-7501 Tel: 757/427-4187 Fax: 757/426-5686 Warren Hon. Jennifer R. Sims 1 East Main Street Tel: 540/635-2435 jsims@courts.state.va.us Front Royal, VA 22630 Fax: 540/636-3274 Washington Hon. Patricia S. Moore 189 East Main Street Tel: 276/676-6224

Waynesboro Hon. Nicole A. Briggs briggsna@ci.waynesboro.va.us Abingdon, VA 24212-0289 276/676-6226 Fax: 276/676-6218 250 South Wayne Avenue Tel: 540/942-6616 P.O. Box 910 Fax: 540/942-6774 Waynesboro, VA 22980-0910 Westmoreland Hon. Gwynne J. Chatham P. O. Box 307 Courthouse Montross, VA 22520-0307 Williamsburg James City County Winchester Wise Wythe Hon. Betsy B. Woolridge Hon. Terry H. Whittle twhittle@courts.state.va.us Hon. J. Jack Kennedy jack@jackkennedy.net Hon. Hayden H. Horney HHorney@courts.state.va.us 5201 Monticello Avenue Suite Six Williamsburg, VA 23188-8218 5 North Kent Street Winchester, Virginia 22601 P.O. Box 1248 206 E. Main Street, Court House Wise, Virginia 24293-1248 Circuit Court Building 225 S. Fourth Street Room 105 Wytheville, VA 24382 York Hon. Lynn S. Mendibur 300 Ballard Street P.O. Box 371 Yorktown, Virginia 23690 Tel: 804/493-0108 Fax: 804/493-0393 Tel: 757/564-2242 Fax: 757/564-2329 Tel: 540/667-5770 Fax: 540/667-6638 Tel: 276/328-6111 Fax: 276/328-0039 Tel: 276/223-6050 Fax: 276/223-6057 Tel: 757/890-3350 Fax: 757/890-3364

APPENDIX F Approval of the Right to Be Eligible to Register to Vote 2 Source: http://www.courts.state.va.us/courts/circuit/resources/manuals/cc_manual_civil/chapter_06.pdf Additional information can be found at: http://www.courts.state.va.us/forms/circuit/cc1402.pdf. A petition filed by a convicted felon seeking court approval of the restoration of the right to be eligible to register to vote. This procedure applies only to the right to vote, not to the other civil rights which are lost upon conviction of a felony. A person must seek restoration of those rights directly by the Governor, through an application filed with the Secretary of the Commonwealth. Procedures: Step 1: Petition is filed with the clerk of the Circuit Court. Petitions are filed in the county of city in which the Petitioner resides or in the county or city in which the individual was convicted. Typical documents filed with the petition would include: o Criminal history; o Letter from Probation Officer outlining period of supervision; o Letters of reference; and o Proof of civic responsibility A Word version is provided below but it can also be found at: http://www.courts.state.va.us/forms/circuit/cc1403.pdf. Step 2: The clerk receipts for filing fee (unless court approves proceeding in forma pauperis), opens a new case file and dockets the case. The cost of filing is approximately $10. You may confirm at the Circuit Court Fee Calculator: http://webdev.courts.state.va.us/cgi-bin/djit/ef_djs_ccfees_calc.cgi#id_calc_frm. Step 3: Hearing held. Step 4: Order entered approving or denying petition. If petition is approved, the order must state that the petitioner's right to be eligible to register to vote may be restored by the date that is ninety days after the date of the court order, subject to the approval or denial of the Governor. Step 5: Clerk provides copy of Approval or Denial Order to the petitioner and sends (fax) a copy to the Secretary of the Commonwealth. (The Secretary of the Commonwealth requests that all documents filed relating to the petition be forwarded with the copy of the court's order.) The Secretary of the Commonwealth shall transmit the order to the Governor for approval or denial. The Secretary of the Commonwealth shall send, within ninety days of the date of the court order, to the petitioner at the address stated on the court's order, a certificate of restoration of that right or notice that the Governor has denied the restoration of that right. Appeal from the denial of restoration from Circuit Court would be to the Supreme Court. There is no right of appeal upon a denial from the Governor. 2 Please note that this appendix was edited for formatting, clarity, and relevant substance for the ROR Guide. For the original material, please check the indicated source.

PETITION FOR APPROVAL OF THE RIGHT TO BE ELIGIBLE TO REGISTER TO VOTE COMMONWEALTH OF VIRGINIA Case No.... To the Circuit Court of I,..., hereby petition this court for approval of this petition seeking NAME OF PETITIONER restoration of my eligibility to register to vote. In support of this petition, I state that the following information is true: 1. My current address and telephone number are:... ADDRESS... TELEPHONE NUMBER 2. The felony conviction(s) which led to the loss of my civil rights was (were):... NAME AND CODE SECTION OF VIOLATIONS for which I was convicted on...in... DATE COURT [ ] ATTACHED ADDITIONAL SHEET(S) 3. As a result of the conviction(s), I received a sentence of,..., of which...was suspended. [ ] I was placed on probation for... 4. I am not currently on probation or parole, nor am I subject to any suspended sentence. 5. At least five years have passed since the completion of any sentence and any modification of sentence, including all periods of probation or parole and any suspension of sentence. 6. I have not been convicted of any criminal violation during the period set out in paragraph 5 above. I understand that this affirmation does not include convictions for traffic infractions. 7. I have demonstrated civic responsibility through the following community or comparable service:......... [ ] ATTACHED ADDITIONAL SHEET(S) In support of this petition, the following documents are attached:......... Based on the above, I petition this Court under Virginia Code 53.1-231.2 for approval of my eligibility to register to vote....... DATE SIGNATURE OF PETITIONER FORM CC-1403

APPENDIX G Notary Public Information Source: http://www.nationalnotary.org/resources_for_notaries/what_is_a_notary/index.html A Notary Public is an official of integrity appointed by state government typically by the secretary of state to serve the public as an impartial witness in performing a variety of official fraud-deterrent acts related to the signing of important documents. These official acts are called notarizations or notarial acts. Notaries are publicly commissioned as ministerial officials, meaning that they are expected to follow written rules without the exercise of significant personal discretion, as would be the case with a judicial official. Impartiality is the byword of the Notary office and the foundation of its public trust. Notaries are duty-bound not to act in situations where they have a personal interest. The public trusts that the Notary s critical screening tasks have not been corrupted by self-interest. And impartiality dictates that a Notary never refuses to serve a person due to race, nationality, religion, politics, sexual orientation or status as a non-customer. Common Places to Find a Notary Public: Banks County or City Government Office County District or Circuit Court Public School Public Library Online directory at http://www.notarypublic.com/. Cost for a Notarial Act: Effective July 1, 2007, a notary public cannot charge more than $5.00 under Virginia law for most notarial acts. http://www.dmbe.virginia.gov/pdf/notary%20hb2058%20notice20007.pdf

APPENDIX H Obtaining a Virginia Identification Card 3 Source: http://www.dmv.state.va.us/webdoc/citizen/id/get_id.asp Note: As of April 21, 2010, the sheriff, jail superintendent, or other jail administrator may issue a government-issued identification card to any prisoner who does not already have an ID. This is known as a special jailer issued identification card. The prisoner must still pay all costs for the card. Va. Code 53.1-116.1:02. If you do not have a driver s license or any other state-issued identification, you may apply for an identification card: Has no age restriction. Is available for an adult or child who does not already hold a learner's permit or driver's license issued from a state within the United States. ID cards expire at the end of the month in which you were born when you reach an age divisible by five; (e.g. 20, 25, 30 etc.) Individuals required to register with the Virginia State Police Sex Offender and Crimes Against Children registry (Virginia Code Chapter 9 of Title 9.1) will be issued ID cards valid for five years. If you are authorized to be in the U.S. temporarily, you will be issued an ID card valid only for the amount of time that you are legally permitted to stay in the U.S. You will not be eligible to receive a limited duration ID card if your authorized stay in the U.S. is less than 30 days from the date of your application. The expiration of the ID card will be the same as the expiration date shown on the document used to prove legal presence. If the document does not show an expiration date, the ID card will be valid for one year. You may exchange your valid Virginia driver's license for an ID card for a $10.00 fee. If you are age 70 or older and have not previously held an ID card, there is no charge for exchanging your license for an ID card. You will be charged the $10.00 fee if you are 70 or older and have previously held an ID card. Required Documents If you are applying for an ID card for the first time and do not hold a valid Virginia driver's license, each time you apply for the ID card, you will be required to show two proofs of identity (only one primary document if you are under age 19), one proof of legal presence and one proof of Virginia residency. You will be required to show these required documents on each return visit until your ID card is issued. Your proof of legal presence must contain your full legal name and date of birth (birth certificate, unexpired passport, unexpired employment authorization document (USCIS form I-766), resident alien card, etc.) Your proof of Virginia residency may include a U.S. marriage certificate, military ID card or discharge papers, social security card, certified copy of school records, department of corrections offender information report, department of education certificate of enrollment form (USCIS form I-797), etc. For a complete list, visit http://www.dmv.state.va.us/webdoc/pdf/dmv141.pdf. If you were born in 1937 or earlier and you want to apply for an ID card, you will not have to provide proof of legal presence if you now hold or previously held a Virginia driver's license or ID card, provided your license or ID card has not been expired for more than 5 years and DMV can verify that it was issued to you. If you do not still have the license or ID card when you apply for your new ID card, be prepared to provide alternative proof that you held the old license or ID card. DMV will attempt to verify your old license or ID card if you cannot provide any alternative proof. 3 Please note that this appendix was edited for formatting, clarity, and relevant substance for the ROR Guide. For the original material, please check the indicated source.

However, if DMV cannot verify its issuance, or you are authorized to be in the U.S. temporarily, you will be required to present one document as proof of legal presence to obtain your new ID card. All documents must be originals. Falsifying information on any driver's license or identification card application is a criminal offense. DMV will assign you a customer number which will display on your ID card. If you wish to change your DMVassigned number in the future, you may be required to present documentation from law enforcement or the courts indicating that you may be a victim of identity theft. Selective Service Registration Generally males under age 26 must register with the Selective Service. If you are required by federal law to register with the Selective Service, you must authorize DMV to forward your personal information to the Selective Service unless you have already registered. If you are under age 18, your parent or guardian must sign your application authorizing the Selective Service to register you when you turn age 18. Law prohibits DMV from issuing any type of driver's license or ID card to an applicant who is required by federal law to register with the Selective Service but who refuses to authorize DMV to send his information to the Selective Service. If you have questions about Selective Service registration, visit the Selective Service website at www.sss.gov or call 847-688-6888 (TTY: 847-688-2567). Completing the Application When applying for an ID card or a hearing-impaired ID card, you must complete a Driver's License, Identification Card, and Voter Registration Application (form DL 1P). Payment An ID card costs $10.00. You may pay your fees with cash, money order, check, check card or major credit card. Issuance You will receive your newly designed secure ID card in the mail. DMV has converted to a new secure process for issuing driver's licenses and ID cards and has discontinued issuing them over the counter. The new secure process is similar to the U. S. passport process and reduces the risks of fraud. If you have renewed your ID card, you can continue to carry your old ID card with your receipt until you receive your new ID card in the mail. Make sure DMV has your current, correct address on record, as your license will be mailed to the address in DMV's records. Notify DMV right away if you have moved. The U.S. Postal Service will not forward driver's licenses.

Office of Vital Records Request for Birth Certificate P.O. Box 1000 Richmond, Virginia 23218-1000 General Information Number: 804-662-6200 APPENDIX I Instructions for Requesting a Copy of Your Birth Certificate 4 We encourage you to mail your letter request to our office. We require 1) a signed letter 2) legible identification documentation (which may include a Virginia Criminal Justice Agency Offender Information Form, United States Probation Offender Information Form) and 3) payment before we can process your order. Please include the information below and payment in your SIGNED letter: Name at birth Date of birth Place of birth Mother's Maiden name Father's name Relationship to the person on the certificate Reason for the certificate Area code + daytime phone number Return address Virginia statutes require a fee of $12.00 be charged each certification of a vital check record or for a search of the files when no certification is made. Please make check or money order payable to the State Health Department. Check and Money Orders are the only accepted method of payment. Please remember to sign the check or money order. Please allow delivery time of 2 to 4 weeks from the date the request is received in this office. Individuals Who Need to Correct Their Gender on a Birth Certificate: The process to change a gender marker on official documents, such as birth certificates, varies from state-to-state. While Virginia s process is clear in terms of procedure, it is less clear in terms of standards for judging who may receive an order, and therefore, may request a new birth certificate. Most courts will require some kind of sex reassignment surgery; however, other procedures have been considered sufficient. The basic procedure is as follows: Step 1: File a petition (sample below) with the Circuit Court in which you reside requesting a gender change, attaching a physician s letter (indicating a GID diagnosis, hormone therapy, surgery/ies), previous name change order (if you had one; sample below; also available at http://www.courts.state.va.us/forms/circuit/cc1411.pdf), and filing fee (approximately $40). Step 2: If the Circuit Court approves the petition, it will issue an order. Then, you must submit the order (along with a name change order, if you have one) to the Vital Records of the state in which you were born. Next, you should receive a corrected birth certificate. Va. Code Ann. 32.1-269(E) (2006). 4 Please note that this appendix, except the name change form below, was edited for formatting, clarity, and relevant substance for the ROR Guide. For the original material, please check the indicated source.

Step 3: After receiving your corrected birth certificate, you should submit these documents to the nearest Social Security office to receive a new card. From there, you can take the gender change order and new Social Security card to the DMV to obtain an ID. Note: A court order may not be necessary if, as a person born in Virginia, you submit acceptable evidence (GID diagnosis, description of any surgical procedure, etc.) and notarized note from your physician directly to the Vital Records Office. 12 Va. Admin. Code 5-550-320 (2006). For additional information, contact Advancement Project s Voter Protection Program, at 1-855-LET-VOTE.

APPLICATION FOR CHANGE OF NAME (ADULT) Commonwealth of Virginia VIRGINIA: In the Circuit Court of the [ ] City [ ] County of... IN RE:... (APPLICANT S NAME) FIRST MIDDLE LAST SUFFIX COMES NOW, the applicant,... and after being duly sworn states under oath as follows: 1. Applicant s Birth Name:... FIRST MIDDLE LAST SUFFIX 2. Residence Address:... STREET ADDRESS... CITY STATE ZIP CODE COUNTRY 3. Mailing Address:... IF DIFFERENT FROM RESIDENCE ADDRESS 4. Date of Birth:... Place of Birth:... 5. Father s Full Name:... FIRST MIDDLE LAST SUFFIX 6. Mother s Full Name:... FIRST MIDDLE MAIDEN CURRENT LAST Answer the following questions by checking appropriate Yes or No box and providing information as requested. 1. Have you ever been convicted of a felony?...[ ] Yes [ ] No 2. Are you currently incarcerated? **...[ ] Yes [ ] No If yes, indicate facility name:... 3. Facility Location:... 4. Are you a probationer with any court?**...[ ] Yes [ ] No If yes, indicate court name:... 5. Have you previously changed your name either by a prior application or by marriage?... [ ] Yes [ ] No (If yes, attach court order or other documentation and indicate previous names):... ** Applications of probationers and incarcerated persons MAY be accepted if the Court finds good cause exists for such application. Attach explanatory documentation to the application. FORM CC-1411 (MASTER, PAGE ONE OF TWO) 05/08 Va. Code 8.01-217

WHEREFORE, the undersigned applicant further certifies under oath that this name change is not sought for any fraudulent purposes and will not infringe upon the rights of others, and pursuant to 8.01-217 of the Code of Virginia, 1950, as amended, the applicant requests that the Court order a change of name from:... FIRST MIDDLE LAST SUFFIX to... FIRST MIDDLE LAST SUFFIX APPLICANT Commonwealth/State of... [ ] City [ ] County of... Subscribed and sworn to/affirmed before me this... day of..., 20... by...... [ ] CLERK [ ] DEPUTY CLERK [ ] NOTARY PUBLIC My commission expires... Registration No.... FORM CC-1411 (MASTER, PAGE TWO OF TWO) 05/08 Va. Code 8.01-217

VIRGINIA: IN THE CIRCUIT COURT OF THE (county or city) OF (name of county of city) IN RE: (full name) s Change of Gender Status CASE NO # PETITION FOR CHANGE OF GENDER STATUS TO THE HONORABLE JUDGES OF THE AFOREMENTIONED COURT: Comes now, (full name), ( ) (social security number in parentheses), petitions this Honorable Court to change (her or his depending on how you currently identify) gender status to (male or female) and as grounds therefore respectfully represents as follows: 1. That your Petitioner resides in (city, county, town) Virginia; 2. That the Petitioner s father is and mother (full legal name), and the mother s maiden name is. 3. That (full name) was born on (date) in the (county or city) of (name of county or city). 4. That (she/he) did, on the (surgery or procedure), in (city and state where surgery or procedure was performed) under the care of (surgeon or physician full name), successfully undergone (name of procedure). 5. That (she/he) desires to correct (her/his) record to reflect the correct gender status; 6. That (she/he) requests the Court to change (her/his) gender status to that of male as evidenced by the enclosed affidavit and his signature on this petition. WHEREFORE, your petitioner prays this honorable Court to change his sex designation to male and to this end all necessary and proper orders be entered pursuant to Section 32. 1-269 of the Code of Virginia, as amended. I Ask For This: (Full name) (Address) (Phone number)

1220 L Street NW Suite 850 Washington, DC 20005 (202) 728-9557