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Further processing of the application cannot occur until all requested information and documents have been supplied.1.Name and seriousness of the crime: FORMTEXT      2.Circumstances under which the crime occurred: FORMTEXT      3.Date(s) of the crime: FORMTEXT      4.Location where crime occurred: FORMTEXT      5.Your age at the time of the crime: FORMTEXT      6.Number of times this same type of crime was committed: FORMTEXT      7.Statement of the social condition which may have contributed to the crime: FORMTEXT      8.Date of indictment, if any (mm/dd/yyyy) : FORMTEXT      9.Date of conviction, if any (mm/dd/yyyy): FORMTEXT      10.Place of indictment/conviction: FORMTEXT      11.Terms of sentence: FORMTEXT      12.Fines imposed, if any: FORMTEXT      13.Terms of probation, if any: FORMTEXT      14If you have served, or are still on probation, please provide a statement from your probation officer attesting to the facts of your probation.15.Submit any evidence of rehabilitation including, but not limited to, the following:Evidence of good conduct while in prison, or in the community; evidence of counseling or psychiatric treatment received; evidence of the acquisition of additional academic or vocation schooling; evidence of successful participation correctional work-release programs; evidence of recommendations of persons who have, or have had, you under their supervision; or a rehabilitation offenders certificate.CERTIFICATIONI, the applicant, being duly sworn according to law, depose and say that the information set forth within this document is true to the best of my knowledge and belief. 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