A. Personal Information
Parts B through D: Answer each question listed by checking the box for Yes or No. Attach certified copies of required documentation for any question answered “Yes.”
B. Civil Judgment
C. Criminal Conviction: Note: Conviction means a plea or verdict of guilty or a conviction following a plea of nolo contendere. (Any conviction dismissed under Penal Code §1203.4 must be included.)
D. Revocation of Registration