(1) the registrant’s full name, including any suffix, and all addresses and places where the registrant resides or habitually lives;

(2) the name and address of each of the registrant’s employers and a description of each location where the registrant performs employment duties, if that location differs from the address of the employer;

(3) the name of the registrant’s educational institution or place of school enrollment and the registrant’s educational institution or school address;

(4) a description of the crime for which the registrant was convicted;

(5) the date that the registrant was convicted;

(6) the jurisdiction and the name of the court in which the registrant was convicted;

(7) a list of any aliases, former names, names by which the registrant legally has been known, traditional names given by family or clan under ethnic or tribal tradition, electronic mail addresses, computer log-in or screen names or identities, instant-messaging identities, and electronic chat room identities that the registrant has used;

(8) the registrant’s Social Security number and any purported Social Security numbers, the registrant’s date of birth, purported dates of birth, and place of birth;

(9) all identifying factors, including a physical description;

(10) a copy of the registrant’s passport or immigration papers;

(11) information regarding any professional licenses the registrant holds;

(12) the license plate number, registration number, and description of any vehicle, including all motor vehicles, boats, and aircraft, owned or regularly operated by the registrant;

(13) the permanent or frequent addresses or locations where all vehicles are kept;

(14) all landline and cellular telephone numbers and any other designations used by the sex offender for the purposes of routing or self-identification in telephonic communications;

(15) a copy of the registrant’s valid driver’s license or identification card;

(16) the registrant’s fingerprints and palm prints;

(17) the criminal history of the sex offender, including the dates of all arrests and convictions, the status of parole, probation, or supervised release, and the existence of any outstanding arrest warrants; and

(18) the registrant’s signature and date signed.

(b) If the registrant is determined to be a sexually violent predator, the registration statement shall also include:

(1) anticipated future residence, if known at the time of registration; and

(2) documentation of treatment received for a mental abnormality or personality disorder.