Secure Request for Notification of Parole Hearings

Secure Request for Notification of Parole Hearings

State of Nevada
This is .... (Check all that apply:)

The first time that I have filled out this form.A change of addressA change of phone numberOther
Offender Information
Please complete:*
Information about the person requesting information
First Name*
Middle Initial or Name
Last Name*
Best e-mail*
The e-mail you use must be verified.

A validation e-mail will be sent to the address you entered. It will come from noreply@jotform.com. After you click "the Verify" button, you will see instructions. Follow the instructions until you see a green message like this E-mail has been verified successfully. Do not proceed until your e-mail has been verified. Click here if you need more help.
Copy-and-paste or retype your email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
(Optional) Phone Extension
The person requesting information is a *

Victim, or relative of a victimThreatened personInterested person
The person requesting information has registered with VINE. (Select one)*

YesNoWhat is VINE?
Complete this secition ONLY If you are NOT the person requesting notification.
Your Name

First NameLast Name
Best phone number to call, if we have questions.
(Optional) Phone Ext.
Best e-mail address to contact, if we have questions.
I am requesting this information because...
Information entered will be e-mailed after it is submitted.

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Secure Request for Notification of Parole Hearings

Information about the person requesting information

Information entered will be e-mailed after it is submitted.

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