fY STATE Oft CALIFORNIA B0F4012(Rev.I1J2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 2ofI3 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 cipleted The application on the following pages sets forth standardized questions to be bi fhe 0GW Phority to deterniine whether a 00W. license shall be issued. The applicant shall not be required to complete ItEi ional application or form for a COW license, or to provide any information other than that necessary to complete this standard application form except to clarify 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 que specifically directed to do so by the licensing agency. I anything in Section 7 unless - t C) 1" CALIFORNIA STATE OJ ' ' 4012 (Roy. 11)2012) 80F DEPARTMENT OF JUSTICE PAGE 3 of 13 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 , Judge Standard 90 Day Reserve Officer fl Q - - Renewal Application Initial Application - - ---- ------ -- - - T. -. PflbbrIIiJrLdI11oflhtIofl io-Z I understand that I am obligated to be complete let and truthful in providing information on this application. I understand that all rncdhv me in this application may be subject to public disclosure. of the information - - - - _- - 5-f3oJ4t -- - Date Date Badge Number - M. -- - - -u— --- --- - -- - lie Nguyen Last Name S Long Middle Name Michael First Name - If Applicable, Maiden Name or Other Names(s) Used - - United States Country of Citizenship San Francisco County of Residence San Francisco City of Residence - Die of Birth M/F Hair Co or Eye Color Weight- Height 2 Applicant Clearance Questions 1. Do you now have, or have you ever had, a license to carry a concealed weapon (CCW)? If yes, pleaseenter the issuing agency name; issue date and QCW license number. Use additional pages if necessary. - - - 1YES []NO 10-25-2012 Butte County Sheriffs-Department 'CW No. Issue Date Tiii1ng Agency Have you ever applied for and been denied a CCW license? If yes, please enter the agency name, date, EIIYES [ONO 2. and the reason for denial. - - Agency Name Reason for Denial - - - Date - - 3. Have you ever held and subsequently renounced your United States citizenship? If yes, please explain. DYES FXINO . 4. If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other RYES than honorable? If yes, please explain. - JNo STATE OF*CALIFORNIA BOF012(Rv.11/2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGE 4OH3 STANDARD INITIAL 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. DYES NNO 6. Are you now, or have you been, subject to a restraining order(s) from any - court? If yes, please explain. EYES nX NO 7. Are you on probation or parole from any state for conviction of any offense including traffic? If yes, please EYES LINO 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. MP20498 Daly City, CA 21453A VC/ Red Light 6-182012 Citation No. Agency Violation/Accident Date Agency Citation No. Violation/Accident Agency Citation No. Date Violation/Accident Agency Citation No. Date Violation/Accident Agency Citation No. Date Violation/Accident Date -' 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 JNO 10. Have you withheld any fact that might affect the decision to approve this license? If yes, please explain. EVES jNO STATE OFCAUF0RNIA B0F4012 (Rev. 11/2012) DEPARTMENT OFJUS110E 5t13 PAGE CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON 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 S arrest. Use additional pages if necessary. 9mm Semi Sig Sauer Serial Number Caliber Model Make Make Model Caliber Serial Number Make Model Caliber Serial Number The licensee js 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 th 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 licen4e shall defend, indennify, and hold harmless the.agency that issued the license, its chief officef 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' 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 weapr and release said agency of any and all liability ariing 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 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 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 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. STATE OFCAUFORNIA' BOF 4012 (Rev. 11/2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OF JUSTICE PAGES of 13 STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON OMNI I accept and assume all responsibility and liability for, injury to, ordeath 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 t0issued t. , and hold harmless the ag ensee connection with any such ac om suc lthn; suit, ott it nip license, its chief officer or an . 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 placd upon it and that misuse of the license rrest and that the license may also be suspended or revoked at -)t vocation a will c, t i. am aware that any use of a firearm may bring criminal action or authority disititinT fl f!ie iU 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 Ctegories attachment to this application. I further acknowledge that ode by state or federal legislative or regulatory bodies and that any these prohibiting cateres can be ai 4d Qf old a CCW license. idr'affectThiigth such amendment or e Date c, jJ ;,: Date -77 1-1 STATE O!"GALIFORNIA BOF 4012 (Rev. I DEPARTMENT PAGE 9 of 13 CALIFORNI A DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON Jct()yW Dat5of Birth Middle Name First Name Applicant Last Name CA Driver License/ID No. Social Security No. Age 7. CA Driver License Restrictions &h 0011011 ess -7p 0 Mailing Address (if different) Spouse/Domestic Partner Last Name 1&v USCJ City State ZiCode Telephone Number (Day) City State Zip Code Telephone Number (Evening) Middle Name First Name Physical Address (71 different than applicant) te Zip Code Telephone Number ' Sta City Name Applicant Occupafion con W poyerA.ddress I City F11A C- S State Zip Cbd List all previous home addresses for the past five years Use addition pages ii 5, Address 5IS(.1' City State City State City / 0-17 CR. State 7iplCode o __ C-ode 0p - City State Zip Cod 2. Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of EYES 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. if yes, please explain. EYES jio STATE Or' CAUFORNIA BOF 4012 (Rev. I V2012) CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS DEPARTMENT OFJUSTICE PAGE 10 of 13 STANDARD' INITIAL AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON 4.. Have you ever been involved in an incident involving firearms? If yes, please explain. 5. Have you ever been involved in a domestic violence incident? If yes, please explain. 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) flYES . NO DYES L1IO riys . If the CCW 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. STATE OFCAUFORNIA B0F4012(Rev.11/2012) DEPARTMENTOFJUSTICE PAGE 11 of 13 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS STANDARD INITJAL'AND RENEWAL APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON ps eeaseof4i adc1aratou --. - 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 as contained 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 be a matter of public record and shall be made available upon request or court order. - I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 5- 13-U ) Date Witness Signature Badge Number Date Hem ?rm-I ws AWARE . v?rE?i Mild .uo. z. Luna 4 License To Carry Concealed Pistol, Revolver, or Otherirear Within the State of California P Issued By: BUTTE CO SHERIFF D, ate of Isue 10/25/12 O/24.Y14 Expira ipate Agency ORI - LocslAaencyNumb Cll# Jerry W SmlthherjfU I 1 Subsequent SECTION A 'nseoIbcens e IA -' B ReSidence Address PARADISE, CA essAddress LONG NGUYEN SA~E BUTTE 4 SeEW bar ttIct1oflS (tfa) -r RiG!RUMB M!, , M — agnat41Jfl Phota(opOfl) M OSl'09117265 I! + REAL ESTATE LEASE and between This Lease Agreement (this "Lease") is dated_4///, ' ("Landlord"), and Michael Nguyen ("Tenant"). The parties agree as foHows PREMISES. Landlord, in consideration of the lease Lease, leases to Tenant (the "Premises") located at CA 94112. - in this San Francisco LEGAL DESCRIPTION. The legal description for the premises is: In Law Unit TERM. The lease term will begin on _______ and will terminate on 91112614 LEASE PAYM. S. Ten' shall pay to Landlord lease payments of $900.00, t day of each month, for a total le "mntof payable in adv e on th ayment 'all be made to Landlorc $900.00. Lea Lanbord ay be changed from tirrTm time Francisco CA, 112 whi - " SECURITY DEPOSIT. A' e time of the signing of this Lease, Tenant shall pay to eposit of $900.00 to be held and disbursed f& Tenant Landlord, in trust, a secu damages to the Premises or other defaults under this Agreement (if any) as provided by law. S POSSESSION. Tenant shall be entitled to posessionon the first day of the term of this Lease, and shall yield possession to Landlord on the last day of the term of this Lease, unless otherwise agreed by both parties in writing. At the expiration of the term, Tenant shall remove its goods and effects and peaceably yield up the Premises to Landlord in as good a condition as when delivered to Tenant, ordinary wear and tear excepted. USE OF PREMISES/ABSENCES. Tenant shall occupy and use the Premises as a dwelling unit. Tenant shall notify Landlord of any anticipated extended absence from the Premises not later than the first day of the extended absence. OCCUPANTS. No more than 2 person(s) may reside on the Premises unless the prior written consent of the Landlord is obtained. PETS. No pets shall be allowed on the Premises. - PROPERTY INSURANCE. Landlord and Tenant shall each be responsible to maintain appropriate insurance for their respective interests in the Premises and property boated on the Premises. RENEWAL TERMS. This Lease shall automatically renew for an additional period of per renewal term, unless either party gives written I ,2 ro'rttk 60 days prior to the end of the term notice of termination no later than or renewal term. - KEYS. Tenant will be given 2 key(s) to the Premises and 0 mailbox key(s). If all keys are not returned to Landlord following termination of the Lease, Tenant shall be charged LOCKOUT. If Tenant becomes locked out of the Premises, Tenant will be charged $0.00 to regain entry. V MAINTENANCE. Landlord shall have the responsibility to maintain the Premises in good repair at all times and perform all repairs necessary to satisfy any implied warranty of habitability: V UTILITIES AND SERVICES. Utilities and services incurred in connection with the V Premises are included. TAXES. Taxes attributable to the Premises or the use of the Premises shall be V allocated as follows: REAL ESTATE TAXES. Landlord shall pay all real estate taxes and assessments for the Premises. PERSONAL TAXES. Landlord shall pay all personal taxes and any other charges which may be levied against the Premises, along with all sales and/or use taxes (if any) that may be due in connection with lease payments. TERMINATION UPON SALE OF PREMISES. Notwithstanding any other provision days' A0 of this Leases Landlord may terminate this lease upon written notice to Tenant that the Premises have been sold. V DESTRUCTION OR CONDEMNATION OF PREMISES. If the Premises are partially destroyed by fire or other casualty to an extent that prevents the conducting of Tenant's use of the Premises in a normal manner, and if the damage. is reasonably repairable within sixty days after the occurrence of the destructions and if the cost of C;, repair is less than $ 5b'O Landlord shall repair the Premises and a just proportion of the lease payments shall abate during the period of the repair according to the extent to which the Premises have been rendered untenantable. However, ifp damage is not repairable within sixty days, or if the cost of repair is $ lfuV or more, or if Landlord is prevented from repairing the damage by forces beyond Landlord's control, or if the property is condemned, this Lease shall terminate upon twenty days' written notice of such event or condition by either party and any unearned rent paid in advance by Tenant shall be apportioned and refunded to it. Tenant shall give Landlord immediate notice- of any damage to the Premises. HABITABILITY. Tenant has inspected the Premises and fixtures (or has had the Premises inspected on behalf of Tenant), and acknowledges that the Premises are in a reasonable and acceptable condition of habitability for their intended use, and the agreed lease payments. are fair and reasonable. If the condition changes so that, in Tenant's opinion, the habitability and rental value of the Premises are adversely affected, Tenant shl1 promptly provide reasonable notice to Landlord. DEFAULTS. Tenant shall be in default of this Lease if Tenant fails to fulfill any lease obligation or term.by which Tenant is bound. Subject to any governing provisions of law to the contrary, if Tenant fails to cure any financial obligation within 5 days (or any other obligation within 10 days) after written notice of such default is provided by Landlord to Tenant, Landlord may elect to cure such default and the cost of such action shall be added to Tenant's financial obligations under this Lease. All sums of money or charges required to be paid by Tenant under this Lease shall be additional rent, whether or not such sums or charges are designated as "additional rent".. The rights provided by this paragraph are cumulative in nature and are in addition to any other rights afforded by law. LATE PAYMENTS. For any payment that is not paid within ..Jfl days after its due date, Tenant shall pay a late fee of $ D HOLDOVER. If Tenant maintains possession of the Premises for any period after the termination of this Lease ("Holdover Period"), Tenant shall pay to Landlord lease payment(s) during the Holdover Period at a rate equal to the normal payment rate set forth in the Renewal Terms paragraph. CUMULATIVE RIGHTS. The rights of the parties under this Lease are cumulative, and shall not be construed as exclusi?e unless otherwise required by law. NON-SUFFICIENT FUNDS. Tenant shall be charged $ is returned to Landlord for lack of sufficient funds. for each check that --p £5 NOTICE. Notices under this Lease shall not be deemed valid unless given or served in writing and forwarded by mail, postage prepaid, addressed to the party at the appropriate address set forth below. Such addresses may be changed from time to time by either party by providing notice as set forth below. Notices mailed in accordance with these provisions shall be deemed received on the third day after posting. LANDLORDy /,UJC 1 - Such addresses may be changed from time to time by either party by providing notice as set forth above. GOVERNING LAW. This Lease shall be construed in accordance with the laws of the State of California. ENTIRE AGREEMENT/AMENDMENT. This Lease contains the entire agreement of the parties and there are no other promises, conditions, understandings or other agreements, whether oral or written, relating to the subject matter of this Lease. This Lease may be modified or amended In writing, if the writing is signed by the party obligated under the amendment. SEVERABiLITY. If any portion of this Lease shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of this Lease is invalid or unenforceable, but that by limiting such provisi9n it would become valid and enforceable, then such provision shall be deemed-to be written, construed, and enforced as so limited WAIVER. The failure of either party to enforce, any provisions of this Lease shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Lease. nd BINDING EFFECT. The provisions of this Lease shall be binding upon and inure to the benefit of both.parties and their respective legal representatives, successors and. assigns. W'1Ni1t1!1-at TENANT: Michael Nguyen RESIDENTIAL LEASE INSPECTION CHECKLIST Tenant has inspected the Premises and states that the Premises are in satisfactory condition, free of defects, except as noted below: SATISFACTORY COMMENTS Bathrootns _X_____ Carpeting Ceilings Closets Dishwasher _N/A____ Disposal Doors Fireplace _Ni/A____ Lights Locks Refrigerator Screens, NIA.... Stave .X____ Walls _X____ Windows Window coverings _N/A____ . . . v" A: . mgr. Ma?iJLu(e'J Dear Sir or Madam, I have been providing professional security services since 2006. Throughout my careerI have been involved with many life-threatening situations. These incidents made me vulnerable to criminal threats and potential attacks in the future. I have prdvidedNational Security Services while employed with Associates, public gire protecion to the board membrs of the nd high-end jewelry transportation foi - to name , 0'st At present, I provide security services for an Francisco. When the een rp~~R the store. On several security manager is car thr occasions, I have to wlk seveial b Ico a high crime , neighborhood in downtown San Francsto 111, I am also responsible for the transportation of high-end jewelry, Director(s), Management, and Staff. On 2/2014 I transported a manager, director, and a sales associate from a high crime area in downtown San Francisco to the San Francisco International Airport. In addition, millions of dollars wofth of Jewelry were in transit at the time as well. I was unarmed. On 3/20141 transported a diamond ring' Diamond Ring Set with White Baguette Diamond Shoulders) worth ariford University. I had to walk several blocks through a high crime area of Market Sifeet to reach my vehicle. I was unarmed. has been robbed many times, totaling almost a billion dollars. The diamonds stolen where.never recovered. Several incidents included former operatives of the Serbi (also known as the "Pink Panthers"). The robberies below show tha has a propensity for criminal attacks: 1980—Two robhetole jewelry from th__Chicago store which was valued wand a 26 carat Marlborough diainondworth ' . Handgimand hand grenades were used. the 13 —A group of armed robbers stole vorkshop location. 2003 Two robbers from the - Pkanthers" worldwide network stole Thcation. -__om - - 2005— 'Three armed robbers stole premises. 2007 -. Two armed robbers st 3m Sloane Street - premises. 2009 Two armed men stole New Bond Street location. l4ars worth ofjewehy frdm - My previous security experience has made me a target for my safety as well: On 2/2012,1 arrested a subject for sexual battery on two womendnring a special event in San Francisco. On 8/2012 unknown person(s) left a death threat note on my vehicle stating they would "kill mewhen I least expected it." I repted the iucidentto the San Francisco Police Department Richmdnd Station (Incident report number In summation, I respectfully request a concealed carry permit for theollowing reasons: (1) Unknown person(s) had threatened to kill me (2) My past security experience and encounters (3) Working foi s (In a High Crime area in Downtown San Francisco) has madTne vulnerable to criminal attacks. • • • • • • • .• • 4 • • • • • • .•. • • •