SThT dF CALIFORNIA 50F4012(Rev. 1112012) DEPARTMENT OF JUSTICE PAGE S0II3 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON fl E Official Use Only Type of License Requested Standard. Judge 90 Day Reserve Officer fl El fl - . - Initial Application fl Renewal Application Public Disclosure Admonition I understand that I am oted to be complete and truthful in providing information on this appliäation. I understand that all fhis application may be subject to public disclosure. of the information disc' Date Applicant Signature LT. Mng f11552 . Date Badge Number Witness Signature Section 1 -Applicant Personal Information VOYTEK First Name GOLDA Last Name Middle Name If Applicable, Maiden Name or Other Names(s) Used P . Weight elht USA Country of Citizenship SAN FRANCISCO COUNTY County of Residence SAN FRANCISCO CityQf.esidence M/F ywui . .. . Section 2 Applicant Clearance Questions 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. - EYES CCW No. Issue Date Issuing Agency 2. Have you ever-applied- for and been denied a CCW license? If yes, please enter the agency name, date, PJYES and the reason for denial. April 2012 and June 2013 San Francisco Sheriffs Department Date Agency Name NO . NO . . Insufficient evidence to establish Good Cause Reason for Denial 3. Have you ever held and subsequently renounced your United States citizenship? If yes, please explain. EYES ONO M NO 4. If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other EYES R than honorable? If yes, please explain. STATE CF CALIFORNIA BOF 4012 (Rev. 1112012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 4of13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON R NO 5. Are you now, Or have you been, a party to a lawsuit in the last five years? If yes, please explain. DYES P. Are you now, or have you been, subject to a restraining order(s) from any court? If yes, pleas, DYES MX NO 7. Are you on probation or parole from any state for conviction of any offense including traffic? If yes, please flYESXn NO explain. 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. Citation ate Violation/Accident Date Violation/Accident Agency Citation No. Date Violatioh/Accident Agency Citation 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. flYES NO - 10. Have you withheld any fact that might affect the decision to approve this license? If yes, please explain. DYES !J NO TATE OF CALIFORNIA BOF 4012 (Rev. 11/2012) DEPARTMENT OF JUSTICE PAGES of 13 .. CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON ..Action 3 Description of Weapons List below the weapons you desire to carry if granted a CCW 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. BERETTA 92FS 9mm Make Model Caliber S W um - Make Model Caliber Serial Number Make Model Caliber Serial Number Secti6n4 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 thelicense. 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 ncealed 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 officer 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 BEFQRE 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 CCW 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. STAT~ 6F CALIFORNIA CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS B0F4012 (Rev. 11/2012) A DEPRTMENTOFJUSTICE PAGE 6 of 13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON 'ction 5 - Applicable California Penal Code 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: Penal Code section 1tatement on Application Form (a) Any person who required by Section 26175 knowing that statements cont1ned '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 mentalinstitution. (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 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 lawfu! 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, mustreally 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 Section 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 person indicted must, upon his trial, be fully 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 knew 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 BOF 4012 (Rev. 11/2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 7 of 13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON çtion 5 Appilcable California Penal Code Sections Continued (b) Except as provided in Section 25105, a person commits the crime of "'criminal storage of a firearm of the second 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 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. (d) The firearm is locked with a locking device, as defined in Section 16860, which has rendered the firearm inoperable. (e) The person is a peace officer or a member of the Armed Forces or the National Guard and the child obtains the firearm S during, or incidental to, the performance of the- person's duties. (f) 1 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 circumstances, that a child is likely to be present on the premise. - Penal Code section 25200 Storage of Firearm whore 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 conceale1:411111120awagon loaded or unloaded, within any premises that are under the person's custody or control. Twj4ut the (2) The person knows or reasonably should know that a child is likely to gain access' tdt permission of the child's parent or legal guardian. (3) The child obtains access to that firearm and thereafter carries that firearm off-premises. (b) 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 five thousand dollars ($5,000), or by both that imprisonment and fine: (1) The person keeps any 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 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, or other 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" means premises other than the premises where the firearm was stored. - Penal Code section 25205 Exceptions Section 25200 does not apply if any of thB 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. 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. - STATE OF CALIFORNIA BOF 4012 (Rev. 11/2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 8 of 13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON ction 6 Agreement to Restrictions and to Hold Harmless 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 a 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 authority 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 CCW 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 CCW 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 such amendment or expansion may affect my eligibility to hold a CCW license. Date LT. Daryl Fong #1552 Witness Signature Badge Number Date STAT4 OF CALIFORNIA OF TICE DEPARTMENT PAGEU: of iS CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS BpF 4012 (Rev. 11/2012) STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON ............. .tIon 7-investigator's InteMew, Notes... . Applicant Last Name First Name iYau oi o,w Age wrci Middle Name security NO. - CA Drivbr Llceflsei1L.ru. ' CA Driver License Restrictions Residence Address City Mailing Address (if different) City State ZipFTelephone Numbey - _ Spouse/Domestic Partner Last Name State Zip Code Telephone NumuerçvenIng) First Nam Physical Address (if different than applicant) Middle Name . ___ City _____ State Zip Code Telephone Number O Business/Employer Narne------ Applicant Occupation _______ Business/Employer *êT ----- (. City - State Zip'tode Telephone NUmoer 1. List all previous home addresses for the past five years. Use additional pages if necessary. _ Address City State Zip Code Address City State Zip Code Address City State Zip Code Address City State Zip Code . 2. Have you ever b'een in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity? If yes, please ex plain. ---- .---- ------- 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 11 program.If yes, please expla in.. - LIYES KNO STATE OF CALIFORNIA 5pF4O12 (Rev. 11/2012) DEPARTMENT OF JUSTICE CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS S PAGE 10 of 13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON tion 7 Investigator's Interview Notes Continued - - 4. Have you ever been involved in an incident involving firearms? If yes, please explain. . flYES ErNO :i Have you ever wen invoivea in a aomestic violence inciclenr? Jr yes, please explain. "YES . .t. 6. List any arrestor formal charges, with or without disposition, for any criminal offenses within the U.S. or any other country (civilian or military) -. .5.. flYES P