- STA. 0 OF CALIFORNIA 130F 101 (Re v. 11/2012) DEPARTMENT OF JUSTICE PAGE 1 of I$ CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION • FOR LICENSE TO CARRY A CONCEALED WEAPON 011 AuthorityL California Penal Code sections 26150 and 26155 provide that a sheriff of a county or the chief or other head of a municipal police department of any city or city and county may issue a license to carry a pistol, revolver, or other firearm capable of being concealed upon the person (CCW license), Penal Code section 26175 requires the Attorney General to prescribe a statewide standard application form for a CCW license. Who May be Issued a License The licensing authority specified in Penal Code sections 26150 and 26155 (a sheriff or the chief or other head of a municipal police department) may issue a license to persons who are of good moral character, who have completed a course of training, and where good cause exists for issuance of the CCW license. All applicants for a COW license will be fingerprinted and state and federal records will be checked to determine if they are eligible to possess firearms. The attachment to this application list all categories tht would prohibit a person from possessing firearms and being granted a CCW!cense. These attachments are updated annually to reflect new legislation and other changes in the law. 0 - Format of CCW License A CCW license may be issued in either of the following formats: 1. A licnse to carry concealed a pistol, revolver, or other firearm capable of being concealed upon the person. 2. Where the population of the county is less than 200,000 persons according to the most recent federal decennial census, a license to carry loaded and exposed in the county a pistol, revolver, or other firearm capable of being concealed upon the person. Ir[tiLugRquird . . Penal Code sections 26150 and 26155 specify that new license applicsnts must complete a course of training. The training may consist of any course acceptable to the licensing authority. The licensing authority may require either a course not to exceed 16 hours which includes Instruction on at least firearms safety and the law regarding the permissible use of a firearm, or a community college course not to exceed 24 hours certified by the Commission on Peace Qffider Standards and Training. If the licensing authority requires the community college course, it must be uniformly required for all CCW ftcense applicants. The licensing authority may also require annual qualification on the weapon(s) during the term for which the CCW license is granted - For license renewal applicants, the course of training may be any course acceptable to the licensing authority, shall be no less than four hours in length, and shall include instruction on firearm safety and the law regarding permissible use of a firearm PwhIQgkLTesting In addition to licensing requirements as specified by the licensing authority; jurisdictions may require psychological testing on the initial application. 'If required, the applicant shall be referred to a licensed psychologist used by the licensing authority for the psychological testing of its own employee. Any fees charged will be the. responsibility of the applicant and such fees shall-not exceed $150.00 for an initial test. Additional psychological testing of an applicant seeking license renewal shall be required only if there is compelling evidence to indicate that a test is necessary. (Pen. Code, § 26190, subd. (f).) STATE OF CALIFORNIA BOF'O12(Rev.11/2O12) CALIFORNIA DEPARTMENT OF JUSTICE DEPARTMENT OF JUSTICE PAGEof 13 BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Completing the Application Answering all the questions on this standard application does not guarantee the issuance of a COW license. The determination whether to issue the license is at the discretion of the licensing authority. Pursuant to Penal Code section 26160, each licensing authority, in addition to using the state standard application form, will have a written policy summarizing what they require. Prior to issuing a CCW license, the statutes require proof that: • The applicant is of good moral character; • Good cause exists to issue the CCW license; • The applicant meets residence requirements; and • The course of training prescribed by the licensing authority has been completed. The application on the following pages sets forth standardized questions to be used by the COW licensing authority to determine whether a COW license shall be issued, The applicant shall not be required to complete any additional application OW license, or to prOy.ide any information other than that necessary to complete this standard application form or form for except to clrify or interpret information provided herein. (Pen. Code, § 26175, subd. (g).) The applicant will certify under penalty of perjury that all answers provided are true and correct to the best of their knowledge and belief. The applicant will also acknowledge. that information disclosed on this application may be subject to public disclosure. Important Instructions 1. Complete, read, and sign Sections 1 through 5, as directed. Use additional pages if more space is required. . 2. Sections 6, 7, and 8 must be completed in the presence of an official of the licensing agency. 3, Review Section 7 and be prepared to answer these questions orally. Do not write anything in Section 7 unless specifically directed to do so by the licensing agency. STATE OF CALIFORNIA SOF4O12(Rv.11f2O12) DEPARTMENT OF JUSTICE PAGE 3oII3 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Official Use Only Type of License Requested Standard Judge El Reserve Officer J El ] 90 Day j Initial Application Renewal Application Public Disclosure Admonition: I understand that I am obligated to be complete and truthful in providing information on this application. I understand that all of the in this application may be subject to public disclosure. O3/Cf.1& Date Signature Badge Number Date Section I Applicant Personal Information, - ___________________ gOp.iwE MCHELE First'Name Last .Name Middle Name If Applicable, Maiden Name or Other Names(s) Used .IAAI FMqI/atfI F/2,q/t/aje) County of Residence City of Residence Country of Citizenship — P - a er th7CTC \/ight H[r1r EkCo] Section 2 Applicant Clearance Questions S - •.• . . - ... 1. Do you now have,. or have you ever had, a license to carry a concealed weapon (CCW)?. If yes, please enter the issuing agency name, issue date and CCW license number. Use additional pages if necessary. . . . EIYES 10 CCW No. Issue. Date Issuing Agercy 2. Have you ever applied for and been denied a CCW license? If yes, please enter the agency name, date, EYES ONO and the reason for denial. . - Date ame Reason for Denial 3. Have you ever held and subsequently renounced your United States citizenship? If yes, please explain. NO EYES S P' 4. If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other 1YES I1NO than honorable? If yes, please explain, S S STATE OF CALIFORNIA B0F4012(Rev.11/2012) DEPARTMENT OF JUSTICE PAGE 4of13 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INJTIAL.AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON 5. Are YOU now, or have you been, a party to a lawsuit in the last five years? If yes, please explain. LIJYES i'NO iio 6. Are you now, or have you been, subject to a restraining order(s) from any court? 1fye- 7. Are you on probation or parole from any state for conviction of any offense including traffic? If yes, please EYES jNO explain. 0• 8. List all traffic violations (moving violations only) and motor vehicle accidents you have had in the last five years. Use additional pages if necessary. 0 i2I Date Date Violation/Accident Agency Citation No. Date Violation/Accident Agency CitatIiflto. Date Violation/Accident Agency Citation No, Date Violation/Accident Agency Citation No. 9. Have you ever been convicted of any criminal offense (civilian or military) in the U.S. or any other country? If yes, please explain including the date, agency, charges and disposition. EYES pl ,io - 10. Have you withheld any fact that might affect the decision to approve this license? If yes, please explain. EYES 10 STATE OF CALIFORNIA B0F4012(Rev.11!2012) DEPARTMENT OF JUSTICE PAGE SofIa CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Section 3 Description of Weapons - List below the weapons you desire to carry if granted a COW license. You may carry concealed only the weapon(s) which you list and describe herein, and only for the purpose indicated. Any misuse will cause an automatic revocation and possible arrest. Use additional pages if necessary. (Lo2J Mdke Model Caliber Oe Fri!lNumbrONOW . Make Model Caliber Serial Number Make Model Caliber Serial Number Section 4 .CCW License Conditions and Restrictions The licensee is responsible for all liability for, injury to, or death of any person, or damage to any property which may result through any act or omission of either the licensee or the agency that issued the license. In the event any claim, suit, or action is brought against the agency that issued the license, its, chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless .the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action. The licensee authorizes the licensing agency to investigate, as they deem necessary, the licensee's record and character to ascertain any and all information which may concern his/her qualifications and justification to be issued a license to carry a concealed weapon and release said agency of any and all liability arising out of such investigation, While exercising the privileges granted to the licensee under the terms of this license, the licensee shall not, when carrying a concealed weapon: • Consume any alcoholic beverage. • Be in a place having a primary purpose of dispensing alcoholic beverages for on-site consumption. • Be under the influence of any medication or drug, whether prescribed or not. • Refuse to show the license or surrender the concealed weapon to, any peace officer upon demand, • Impede any peace officer in the performance of his/her duties. • Present himself/herself as a peace officer to any person unless he/she is, in fact, a peace off icer as defined by California law. Unjustifiably display a concealed weapon. • Carry a concealed weapon not listed on the permit. • Carry a concealed weapon at times or circumstances other than those specified in the permit. ' Title 49, section 46505 of the United States Code states that a license to carry a concealed weapon does not authorize a person to carry a firearm, tear gas, or any dangerous weapon aboard commercial airlines. Further, a person must declare that he/she is carrying such firearm, tear gas, or any dangerous weapon BEFORE, entering the boarding area of an air terminal where the security checks are made. Such violation can result in arrest by law enforcement. Any violation of these restrictions or conditions may invalidate the COW license and may void any further use of the license until reinstated by the licensing authority. Any arrest for a felony or serious misdemeanor, including driving under the influence of alcohol and/or drugs, is cause for invalidating the license. STATE OF CALIFORNIA BOF 4012 (Rev. 11/2012) CALIFORNIA DEPARTMENT OF JUSTICE DEPARTMENT PAGE 6 of 13 BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Section 5 - Applicable California Penal Cbde Sections The following Penal Code sections are of special importance to the holder of a CCW license regarding the use, carrying, and storage of firearms: Penalerle sectit4$8,0 False Statement on Application Form - perSQ vli'l1s an application required by Section 26175 knowing that statements contained therein are false is guilty of a misdemeanor. (b) Any person who knowingly makes a false statement on the application regarding any of the following is guilty of a felony. (1). The denial or revocation of a license, or the denial of an amendment to a license, issued pursuant to this article. (2) A criminal conviction. (3) A finding of not guilty by reason of insanity. (4) The use of a controlled substance. (5) A dishonorable discharge from military service. (6) A commitment to a mental institution. (7) A renunciation of United States citizenship. . Penal Code section 192 Manslaughter - Manslaughter is the unlawful killing of a human being without malice. (a) Voluntary upon a sudden quarrel or heat of passion. (b) Involuntary in the commission of an unlawful act, not amounting to a felony; or in the commission of a lawful act which might produce death, in an unlawful manner, or without due caution and circumspection. This subdivision shall not apply to acts committed in the driving of a vehicle.' - -. Penal Code section 197 Justifiable Homicide; Any Person - Homicide is also justifiable when committed by any person in any of the following cases: When resisting any attempt to murder any person, or to commit a felony, or to do some great bodily injury upon any 1. person; or, When committed in defense of habitation, property, or person, against one who manifestly intends or endeavors, by 2. violence or surprise, to commit a felony, or against one who manifestly intends and endeavors, in a violent, riotous or tumultuous manner, to enter the habitation of another for the purpose of offering violence to any person therein;- or When committed in the lawful defense of such person, or of a wife or husband, parent, child, master, mistress or 3. servant of such person, when there is reasonable ground to apprehend a design to commit a felony or to do some great bodily injury, and imminent danger of such design being accomplished; but such person, or the person in whose behalf the defense was made, if he was the assailant or engaged in mutual combat, must really and in good faith have endeavored to decline any further struggle before the homicide was committed; or When necessarily committed in attempting, by lawful ways and means, to apprehend any person for any felony 4. committed, or in lawfully suppressing any riot, or in lawfully keeping and preserving the peace. Penal Code section 198 Justifiable Homicide; Sufficiency of Fear - A bare fear of the commission of any of the offenses mentioned in subdivisions 2 and 3 of Sectioh 197, to prevent which homicide may be lawfully committed, is not sufficient to justify it. But the circumstances must be sufficient to excite the fears of a reasonable person, and the party killing must have acted under the influence of such fears alone. Penal Code section 199 Justifiable and Excusable Homicide; Discharge of Defendant - The homicide appearing to be justifiable or excusable, the peron indicted must, upon his trial, be fulls' acquitted and discharged, Penal Code section 25100 Criminal Storage of Firearm - (a) Except as provided in Section 25105, a person commits the crime of "criminal storage of a firearm of the first degree" if all of the following conditions are satisfied. (1) The person keeps any loaded firearm within any premises that are under the person's custody or control. (2) The person knows or reasonably should know that a child is likely to gain access to the firearm without the permission of the child's parent or legal guardian. (3) The child obtains access to the firearm and thereby causes death or great bodily injury to the child or any other person. STATE OF CALIFORNIA B0F4012(Rev 11/2012) V DEPARTMENT OF '.ALlFORNlA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS PAGE 7oII3 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Section 5.- Applicable California Penal Code Sections Continued (b) Except as provided in Section 25105, a person commit the crime of 'criminal storage of a firearm of the second degree" if all of the following conditions are satisfied: (I) The person keeps any loaded firearm within any premises that are under the person's custody or control. (2) The person knows or reasonably should know that a child is likely to gain access to the firearrri without the permission of the child's parent or legal guardian. (3) The child obtains access to the firearm and thereby causes injury, other than great bodily injury, to the child or any other person, or carries the firearm either to a public place or in violation of Section 417. - Penal Code section 25105 Exceptions Section.25100 does not apply whenever any of the following occurs: ('a) The child obtains the firearm as a result of an illegal entry to any premises by any person. (b) The firearm is kept in a locked container or in a location that a reasonable person would believe to be secure. (c) The firearm is carried on the person or within close enough proximity thereto that the individual can readily retrieve and use the firearm as if carried on the person. The firearm is locked with a locking device, as defined in Section 16860, which has rendered the firearm inoperable. (d) (e). The person is a peace officer or a member of the Armed Forces or the National Guard and the child obtains the firearm during, or incidental to, the performance of the person's duties. (f) The child obtains, or obtains and discharges, the firearm in a lawful act of self-defense for defense of another person. (g) The person who keeps a loaded firearm on any premise that is under the person's custody or control has no reasonable expectation, based on objective facts and cirdurnstances, that a child is likely to be present on the premise. - Penal Code section 25200 Storage of Firearm where Child Obtains Access and Carries Firearm Off-Premises (a) If all of the following conditions 'are satisfied, a person shall be punished by imprisonment in a county jail not exceeding one year, by a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine: (1) The person keeps a pistol, revolver, or other firearm capable of being concealed upon the person, loaded or unloaded, within any premises that are under the person's custody or control. (2) The person knows or reasonably should know that a child is likely to gain access to th%fnarm without permission of the child's parent or legal guardian. (3) The child obtains access to that firearm and thereafter carries that firearm off-premises. ' 'en t iji ajounty jail,. notexceeding (b) If all of the following conditions are satisfied a person shall be punished by io'iM"onm irnprionrteiit üid fine one year, by a fine not exceeding five thousand dollars ($5, 000), or by both tl 4W i The person keeps any firearrñ within any premises that are under the person's custody o'ddhfrol' (1) (2) The person knows or reasonably should know that a child is likely gain access to the firearm without the permission of the child's parent or legal guardian. (3) The child obtains access to the firearm and thereafter carries that firearm off-premises to any public or private preschool, elementary school, middle school, high school, or to any school-sponsored event, activity, or performance, whether occurring on school grounds or elsewhere. (c) A pistol, revolver, orother firearm capable of being concealed upon the person that a child gains access to and carries off-premises in violation of this section shall be deemed "used in the commission of any misdemeanor as provided in this code or any felony" for the purpose of Section 29300 regarding the authority to confiscate firearms and other deadly weapons as a nuisance. (d) As used in this section, "off-premises" mans premises other than the premises where the firearm was stored. - - Penal Code section 25205 Exceptions Section 25200 does not apply if any of the following are true: (a) The child obtains the firearm as a result of an illegal entry into any premises by any person. (b) The firearm is kept in a locked container or in a location that a reasonable person would believe to be secure. (c) The firearm is locked with a locking device, as defined in Section 16860, which has rendered the firearm inoperable. (d) The firearm is carried on the person within close enough range that the individual can readily retrieve and use the firearm as if carried on the person. (e) The person is a peace officer or a member of the Armed Forces or National Guard and the child obtains the firearm during, or incidental-to, the performance of the person's duties. (f) The child obtains, or obtains and discharges, the firearm in a lawful act of self-defense or defense of another person. (g) The person who keeps a firearm has no reasonable expectation, based on objective facts and circumstances, that a child is likely to be present on the premises. - ' V STATE OF CALIFORNIA 00F4012(ROv. 11/2012) LALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 8OFI3 STANDARD INITIAL AND RENEWAL APPLICATION. FOR LICENSE TO CARRY A CONCEALED WEAPON Section 6 Agreement to estrictiorisáñd fo Hold Hairritess - I accept and assume all responsibility and liability for, injury to, or death of any person, or damage to any property which may result through an act or omission of either the licensee or the agency that issued the license. In the event any claim, suit or action is brought against the agency that issued the license, its chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action. I understand that the acceptance of any application -by the licensing authority does not guarantee the issuance of a license and that fees and costs are not refundable if denied. I further understand that if my application Is approved and I am issued license to carry a concealed weapon, that the license is subject to restrictions placed upon it and that misuse of the license will cause an automatic revocation and possible arrest and that the license may also be suspended or revoked at the discretion of the licensing authorit? at any time. I am aware that any use of a firearm may bring criminal action or civil liability against me. I have read, understand, and agree to the COW license liability clauses, conditions, and restrictions stated in this application and Agreement to Restrictions and to Hold Harmless. I have read and understand the applicable Penal Code sections regarding false statements on a COW Application, manslaughter, killing in defense of self or property, limitation on self-defense and defense of property, and child access and firearm storage, stated in this application. I have, read and understand the Firearms Prohibiting Categories attachment to this application. I further acknowledge that these prohibiting categories can be amended or expanded by state or federal legislative or regulatory bodies and that any suchamendment or expansion may affect my eligibility to hold a COW license. Date, (f Date STATE OF CALIFORNiA BOF 4012 (Rev 11/2012) 0 'AL1FORNIA.DEPARTMENT OF JUSTICE RTMENT OF JLISTIC~ PAGE 10 of 13 BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Section 7 Invest,gatorrs Intervietotes Continued - - - 4. Have you ever been involved in. an incident involving firearms? If yes, please explain, EYES f'No 5. Have you ever been involved in a domestic violence incident? If yes, please explain. EYES jN0 6. List any arrest or formal charges, With or without disposition, fo any criminal offenses within the U.S. or. any other country (civilian or military). EYES k-/(NO - 0 If the COW license is desired for self-protection, the protection of others, or for the protection of large sums of money or valuable property, you are required to explain and provide good cause for issuance of the license. For example, has your life or property been threatened or jeopardized? Explain incidents and include dates, times, locations, and names of police agencies to which these incidents were reported. Details of Reason for Applicant Desiring a CCW license. Use additional pages if necessary. iAP4 .1 & p/v9/j &/ 000 2I'7fld LC/ y trflt . fr' 444f /* L4W / alnd / In iiu1 7( jd)1 4 q j evad 0 O4A . •0 STATE OF CALIFORNIA BOF4012(Rev. 11/2012) Section 7 - PAGE 9 of 13 Investigators Interview Notes Applicant Last Name iii: DEPARTMENTOFJUSflCE CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON ra Date of Birth First Name Middle Name TTLT 2 TJ CA Driver License/ID No. ______ Age Social Security No. CA Driver License Restrictions Thi7'rEr 69 . Residence Address City State ZiC Mailing Address (if different) City State Zip Code Telephone Number (Evening) Spouse/Domestic Partner Last Name First Name Physical Address (if diffOrentttian applicant) Middle Name City State Zip Code Telephone Number Business/Employer Name Applicant Occupation State Zip Code Telephone Number City Business/Employer Address 1. List aUp Telephone NumTber (DW i2LhQe asses for the past five years. Use additional pages if necessary. ) State S 'Ot1T1A1I9/V MAiAf(o C' City __ CityIV dress City "91Vdl - de ____ State 11p Code State ZiCode State Z115 Code 2. Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity? If yes, please explain. . 3. Are you, now, or have you ever been, addicted to a controlled substance or alcohol, or have you ever utilized an illegal controlled substance, or have you ever reported to a detoxification or drug treatment program. IT yes, piease explain. - LIYES VNO • • 'STATE OF CALIFORNIA SOP 4012 (Rev. 11/2012) DEPARTMENT OF JUSTICE PAGE 12 of 13 ATTACHMENT ' CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS FIREARMS PROHIBITING CATEGORIES State and federal law make it unlawful for certain persons to own and/or possess firearms, including: • Any person who is convicted of a felony, or any offense enumerated in Penal Code sections 29900 or 29905 • Any person who is ordered to not possess firearms as a condition of probation or other court order listed in Penal Code section29815, subdivisions (a) and (b) • Any person who is convicted of a misdemeanor listed In Penal Code section 29805 (refer to List of Prohibiting Misdemeanors) Any person who is adjudged a ward of the juvenile court because he or she committed an offense listed in Welfare and Institutions Code section 707(b), an offense described in Penal Code section 1203.073(b), or any offense enumerated in Pnal Code section 29805 627 &N , 8a Any person who is Subject to a temporary restraining order or an injunction Issued pursuant to Code ofiIl FFteJU1L3 flecito rs. ,27,6' i ajotective protective order as defined in Family Code section 6218 a protective order issued pursuant to Penal Cod ections 18 2 or order issued pursuant to Welfare and Institutions Code section 15657.03 • Any person who is found by a court to be a danger to himself, herself, or others because of a mental illness, - Any person who is found by a court to be mentally incompetent to stand trial -- • Any person who is found by a court to be not 'guilty by reason of insanity • Any person who is adjudicated to be a mentally disordered sex offender • Any person who is placed on a conservatorship because he or she is gravely disabled as a result of a mental disorder, or an impairment by chronic alcoholism • • • • • Any person who communicates a threat to a licensed psychotherapist against a reasonably identifiable victim, that has been reported by the psychotherapist to law enforcement • Any person who is taken into custody as a danger to sell or others under Welfare and Institutions Code section 5150, assessed under Welfare and Institutions Code section 5151, and admitted to a mental health facility under Welfare and Institutions Code sections 5151, 5152, or certified under Welfare and Institutions Code sections 5250, 5260, and 5270.15 • Any person who is addicted to the use of narcotics (state and federal) • Any person who is under indictment or information in any court for a crime punishable by imprisonment for a term exceeding one year (federal) • Any person who has been discharged from the military under dishonorable conditions (federal) •' Any person who is an illegal alien (federal) • Any person who has renounced his or her US Citizenship (federal) • Any person who Is a fugitive from justice (federal) STATE.Or CALIFORNIA BOF 4012 (ReV 1112012) DEPARTMENT eALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS PAGE 11 of 13 - STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY.A CONCEALED WEAPON Section 8 Release of Information and Declaration - : I herby give permission to the agency to which this application is made to conduct a background investigation of me and to contact any person or agency who may add to or aid in this investigation. I further authorize persons, firms, agencies and institutions listed on this application to release or confirm information about me and statements I have made ascontained in this application. Notwithstanding any other provision of law - and pursuant to the Public Records Act (Government Code section 6250 et seq.), I understand that information contained in this application may bea matter of public record and shall be made available upon request or court order. - is true and correct. Dat Date - STATE OF CALIFORNIA BOF 4012 (Roy. 11/2012) DEPARTMENT OF JUSTICE PAGE 13 of 13 ATTACHMENT CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS MU FIREARMS PROHIBITING CATEGORIES 0. Firearm prohibitions for misdemeanor violations of the offenses listed below are generally for ten years from the date of conviction, but the duration of each prohibition may vary. All statutory references are to the California Penal Code, unless otherwise indicated. • Threatening public officers, employees, and school officials (Pen. Code, § 71.) • Threatening certain public officers, appointees, judges, staff or their families with.the intent and apparent ability to carry out the threat (Pen. Code, § 76.) Intimidating witnesses or Victims (Pen. Code, § 136.1.) • Possessing a deadly weapon with the intent to Intimidate a witness (Pen. Code, § 136.5.) • Threatening witnesses, victims, or informants (Pen. Code, § 140.) • Attempting to remove or take a firearm from the person or immediate presence of a public or peace officer (Pen. Code, § 148(d)) • Unauthorized possession of a weapon in a courtroom. Courthouse, or court building, or at a public meeting (Pen. Code, § 171(b).) Bringing into or possessing a loaded firearm within the state capitol, legislative offices, etc. (Pen. Code, § 171(c).) Taking into or possessing loaded firearms within the Governor's Mansion or residence of other constitutional officers (Pen. Code, 171(d).) • Supplying, selling or giving possession of a firearm to a person for participation In criminal street gangs (Pen. Code, § 186.28.) Assault (Pen. Code, § 240, 241.) • Battery (Pen. Code, § 242, 243.) • Sexual Battery (Pen. Code, § 243.4) Assault with a stun gun or taser weapon (Pen. Code, § 244.5.) • Assault with a deadly weapon other than a firearm, or with force likely to produce great bodily Injury (Pen. Code, § 245.) • Assault with a deadly weapon or Instrument; by any means likely to produce great bodily injury or with a stun gun or taser on a school employee engaged in performance of duties (Pen. Code, § 245.5.) • Discharging a firearm in a grossly negligent manner (Pen. Code, § 246.3.) • Shooting at an unoccupied aircraft, motor vehicle, or uninhabited building or dwelling house (Pen. Code, § 247.) • Inflicting corporal Injury on a spouse or significant other (Pen. Code, § 273.5,)* • Wilfully violating a domestic protective order (Pen. Code, § 273.6.) • Drawing, exhibiting, or using deadly weapon other than a firearm (Pen. Code, § 417, subd. (a)(1) & (a)(2).) • Inflicting serious bodily Injury as B result of brandishing (Pen. Code, § 417.6.) • Making threats to commit a crime which will result in death or great bodily Injury to another person (Pen. Code, § 422.) 'Bringing into or possessing firearms upon or within public schools and grounds (Pen. Code, § 626,9.) • Stalking (Pen. Code, § 646.9.) • Armed criminal action (Pen, Code, § 25800.) • Possessing a deadly weapon with intent to commit an assault (Pen. Code, § 17500.) • Driver of any vehicle who knowingly permits another person to discharge a firearm from the vehicle or any parson who willfully and maliciously discharges a firearm from a motor vehicle (Pen. Code, § 26100,' subd. (b) or (d).) • Criminal possession of a firearm (Pen. Code, § 25300.) • Firearms dealer who sells, transfers or gives possession of any firearm to a minor or a handgun to a person under 21 (Pen, Code, § 27510.) • Various violations involving sales and transfers of firearms (Pen, Code, § 27590, subd. (c)) • Person or corporation who sells any concealable firearm to any minor (former Pen. Code, § 12100, subd. (a).) • Unauthorized possession/transportation of a machine gun (Pen. Code, § 32625) • Possession of ammunition designed to penetrate metal or 6rmor (Pen. Code, § 30315.) • Carrying a concealed or loaded firearm or other deadly weapon or wearing a peace officer uniform while picketing (Pen. Code, §§ 830.95, subd. (a), 17510, subd. (a.) • Bringing firearm related contraband into juvenile hail (Weif. & lnst, Code, § 871.5.) • Bringing firearm related contraband into a youth authority institution (Weif, & Inst. Code, § 1001.5.) • Purchase, possession, or receipt of a firearm or deadly weapon by a person receiving in-patient treatment for a mental disorder, or by a person who has communicated to a licensed psychotherapist a serious threat of physical violence against an identifiable victim (Waif. & Inst. Code, § 8100) • Providing a firearm or deadly weapon to a person des'cnibed in Welfare and Institutions Code sections 6100 or 8103 (WeIf. & Inst. Code, § 8101.) • Purchase, possession, or receipt of a firearm or deadly weapon by a person who has been adjudicated to be a mentally disordered sex offender or found to be mentally incompetent to stand trial,, or not guilty by reason of insanity, and Individuals placed under conservatorship (\Nelf, & Inst. Code, § 8103) - . The following misdemeanor convictions result in a lifetime prohibition: • Assault with a firearm (Pen, Code, §§ 29800, subd. (a)(1), 23515, subd. (a).) • Shooting at an Inhabited or occupied dwelling house, building, vehicle, aircraft, housecar or camper (Pen. Code, §§ 246, 29800, subd. (a)(1), 17510, 23515, subd. (b).) • Brandishing a firearm in presence of a peace officer (Pen. Code § 417, subd. (c), 23515, subd. (d), 29800, subd. (a)(1)'.) • Two or more convictions of Penal Code section 417, subdivision (a)(2) (Pen. Code § 29800, subd. (a)(2).) . * A "misdemeanor crime of domestic violence" (18 U.S.C. §§ 921 (a)(33)(A), 922(g)(9).) Note: The Department of Justice provides this document for informational purposes only. This list may not be inclusive of all firearms prohibitions. For specific legal advice, please consult with an attorney licensed to practice law in California. . -