If “YES,” you must submit with this application a written explanation giving the place, court jurisdiction, nature of the offense, sentence and /or other disposition. If you possess or have received a Cerfificate for Relief from Disabilities, Certificate of Good Conduct or Executive Pardon, you must submit a copy with this application.

If “YES,” you must submit a copy of the accusatory instrument (e.g. indictment, criminal information or complaint) from the court.

SECTION FOUR - APPLICANT AFFIRMATION

Applicant Affirmation — I affirm, under the penalties of perjury, that the statements made in this application are true and correct. I further affirm that I have read and understand the provisions of Article 28 of the General Business Law and the rules and regulations promulgated thereunder.