Fillable Incorrect Cori (Commonwealth of Massachusetts)

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Incorrect Cori (Commonwealth of Massachusetts)

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U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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COMPLAINT FORM
Incorrect Criminal Offender Record Information
THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY
Department of Criminal Justice Information Services
200 Arlington Street, Suite 2200, Chelsea, MA 02150
TEL: 617-660-4600 | TTY: 617-660-4606 | FAX: 617-660-4613
mass.gov/cjis
Complaint Type:
Incorrect CORI
Agency/Organization:Organization:
Name:
Current Address:
City:
State:
Zip Code:
Country:
Last
First
Middle
Suffix
Apt/Unit:
Former Address:
City:
State:
Zip Code:
Country:
Apt/Unit:
Phone Number 1:
Phone Number 2:
E-mail:
E-mail:
Date of Birth:
Month
Day
Year
Social Security Number:
Names Previously Used:
LastFirst Middle Suffix
LastFirst Middle Suffix
LastFirst Middle Suffix
Hair Color:Height: Weight: Eye Color:
Mother Maiden Name:
Father's Name:
Title
Description of Complaint:
1. List all criminal offenses that presently appear on your CORI that you allege are inaccurate. Include the
arraignment date, court, docket number, and offense for each charge. Attach additional sheets if
necessary.*
2. Provide a detailed explanation of why you believe the identified CORI data is inaccurate.*
3. State the steps you have taken, if any, to correct the inaccurate CORI.*
4. State the correction you believe is necessary to correct the inaccurate CORI.*
Attach/Include Files
1. Please attach/include any documentation or correspondence you may have to support your complaint.
2. Please attach/include a legible copy of Government-issued, photo identification.
Submit Complaint
This completed complaint form and all required and available supporting documentation must be mailed
to the following:
Massachusetts Department of Criminal Justice Information Services
ATTN: Legal Department
200 Arlington Street, Suite 2200, Chelsea MA 02150
By signing below, I attest that the information provided in this complaint, and in support thereof, is
true to the best of my knowledge.
Signed under the penalties of perjury.
Name Signature Date
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Incorrect Cori (Commonwealth of Massachusetts)

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Completed 27 July 2020

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