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ROBERT L. EHRLICH, JR., Governor
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Ch. 375
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(3) A STATEMENT THAT DISCLOSURE OF THE APPLICANT'S ACTUAL
ADDRESS WOULD ENDANGER THE APPLICANT'S SAFETY OR THE SAFETY OF THE
APPLICANTS CHILD;
(4) A KNOWING AND VOLUNTARY DESIGNATION OF THE SECRETARY OF
STATE AS AGENT FOR PURPOSES OF SERVICE OF PROCESS AND RECEIPT OF
FIRST-CLASS, CERTIFIED, OR REGISTERED MAIL;
(5) THE MAILING ADDRESS AND TELEPHONE NUMBER WHERE THE
APPLICANT MAY BE CONTACTED BY THE SECRETARY OF STATE;
(6) THE ACTUAL ADDRESS THAT THE APPLICANT REQUESTS NOT BE
DISCLOSED BY THE SECRETARY OF STATE BECAUSE IT WOULD INCREASE THE RISK
OF DOMESTIC VIOLENCE;
(7) A STATEMENT AS TO WHETHER THERE IS ANY EXISTING COURT
ORDER OR PENDING COURT ACTION INVOLVING THE APPLICANT AND RELATED TO
DIVORCE PROCEEDINGS, CHILD SUPPORT, CHILD CUSTODY, OR CHILD VISITATION,
AND THE COURT THAT ISSUED THE ORDER OR HAS JURISDICTION OVER THE ACTION;
(8) A SWORN STATEMENT BY THE APPLICANT THAT TO THE BEST OF
THE APPLICANT'S KNOWLEDGE ALL OF THE INFORMATION CONTAINED IN THE
APPLICATION IS TRUE; AND
(9) THE SIGNATURE OF THE APPLICANT AND THE DATE ON WHICH THE
APPLICANT SIGNED THE APPLICATION; AND
(10) A VOLUNTARY RELEASE AND WAIVER OF ALL FUTURE CLAIMS
AGAINST THE STATE FOR ANY CLAIM THAT MAY ARISE FROM PARTICIPATION IN THE
PROGRAM EXCEPT FOR A CLAIM BASED ON GROSS NEGLIGENCE.
(C) (1) (I) ON THE FILING OF A PROPERLY COMPLETED APPLICATION AND
RELEASE. THE SECRETARY OF STATE SHALL CERTIFY:
1. REVIEW THE APPLICATION AND RELEASE; AND
2. IF THE APPLICATION AND RELEASE ARE PROPERLY
COMPLETED AND ACCURATE. DESIGNATE THE APPLICANT AS A PROGRAM
PARTICIPANT.
(II) APPLICANTS AN APPLICANT SHALL BE CERTIFIED A
PARTICIPANT FOR 4 YEARS FROM THE DATE OF FILING UNLESS THE CERTIFICATION
PARTICIPATION IS CANCELED OR WITHDRAWN PRIOR TO THE END OF THE 4-YEAR
PERIOD.
(2) A PROGRAM PARTICIPANT MAY WITHDRAW A CERTIFICATION FROM
PARTICIPATION BY FILING A SIGNED, NOTARIZED REQUEST FOR WITHDRAWAL WITH
THE SECRETARY OF STATE.
4-523.
(A) IF AN APPLICANT FALSELY ATTESTS IN AN APPLICATION THAT
DISCLOSURE OF THE APPLICANT'S ACTUAL ADDRESS WOULD ENDANGER THE
- 2033 -
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