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Get VA 851_F1 2014-2024

VIRGINIA DEPARTMENT OF CORRECTIONS Adult Visitor Application and Background Investigation Authorization 851F11-14 For use if age 18 or over or if emancipated minor By completing this request and authorization I acknowledge that visitation of offenders at a DOC facility is a privilege. A Visiting Brochure is available upon request. PLEASE PRINT LEGIBLY ALL SPACES MUST BE COMPLETELY FILLED OUT Visitor Information Check Box if Emancipated Minor Visitor s Legal Last Name Race Hair Color Gender Eye Height Your Current Mailing Address MI MM DMV or ID Card Number DD YYYY Date of Birth SSN last 4 Place of Birth County or City and State/Country Information on Offender You Want to Visit Street Address Offender s Incarcerated Name Number First and Last City or Town of Residence State Zip Country Offender s Facility Your legal relationship to Offender If none state none e-mail Address Phone Number Vehicle Information Make Model Year Plate Number List first and last name of visitors under age 18 accompanying you and check whether you are the child s parent or legal guardian. Attach a Minor Visitor Application and Background Investigation Authorization for each child First and Last Name Parent/ Guardian Yes No You must provide written notarized approval from the parent or legal guardian for visitors under 18 years old if you are not the parent or legal guardian of these visitors. This privilege may be revoked or suspended for violation of rules overcrowding or as a result of suspicious behavior. Conditions No Have you been convicted of a felony in any jurisdiction No Have you ever been employed by volunteered with or contracted by the Department of Corrections or Department of Correctional Education No Are you currently under active parole or probation supervision If you are on supervision you must have written permission from your chief parole officer and the Warden/Superintendent of this facility. No Are you a victim of the current crime committed by the offender with whom you wish to visit No Are you now or have you ever been a member or associated with any gang motorcycle club racial supremacy group or other such group or organization as defined in Code of Virginia 18. 2-46. 1 I authorize the Department of Corrections to conduct a criminal records check or to use any Department of Corrections records to verify accuracy of information provided on this form* The above information is true and correct. I understand that providing false information on this form is grounds for denying visiting privileges. I have read and understand the above statements. Signature Date Mail to Visitor Registration Unit P. Conditions No Have you been convicted of a felony in any jurisdiction No Have you ever been employed by volunteered with or contracted by the Department of Corrections or Department of Correctional Education No Are you currently under active parole or probation supervision If you are on supervision you must have written permission from your chief parole officer and the Warden/Superintendent of this facility. No Are you a victim of the current crime committed by the offender with whom you wish to visit No Are you now or have you ever been a member or associated with any gang motorcycle club racial supremacy group or other such group or organization as defined in Code of Virginia 18. .

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