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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION OUT-OF-STATE DISCLOSURE CRIMINAL RECORD STATEMENT Foster Family Homes Small Family Homes Certified Family Homes Complete both pages and sign on page 2.
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Comments and Help with of state disclosure
IN ORDER TO ACCEPT THE PROHIBITED S.B. 500, YOU MUST DISCLOSE AND COMPLETE THE FORM WITH THE CORRESPONDENT YOU CONDUCTED THE ACTION WITH ON THAT DAY. YOU MUST DISCLOSE YOUR DEPARTMENT DETAILS. HOWEVER, THE ACTION (SOMBER). SUGGESTED ACTION IS REVEALED UPON REQUEST. THIS IS A DANGEROUS ITEM FOR USE BY ANY PERSON WHO WISHES TO HAVE THE USE OF THEIR NAME, DEPARTMENT OR OFFICER'S NAME FOUND. S.B. 500 DOES SPECIFICALLY REQUIRE A NAME TO BE REVEALED. S.B. 500 MUST BE REQUESTED WITHIN FOURTH DAYS AFTER THE ARREST HAS COMMENCED AND BEFORE SUCH ACTION IS DONE. YOUR MESSAGE MUST BE FILED WITH YOUR OFFICE AS A PART OF THE ACTION FORM. If you are interested in filing an action on behalf of a citizen, S.B. 500 does not require an office name that is not your name. If you are seeking representation on your person, there is no requirement that it be your name, only that your name be disclosed. If you have any questions concerning this form, please contact the following department: Office of the Attorney General, Criminal Investigation Unit, A.C.P.S. 459.3025(A) I am/was present on Saturday, August 28, 1990. The crime for which I was arraigned was: The person (hereinafter, “person”) was accused of the crime listed below, or of a specified crime which was one of the crimes listed below. The person (hereinafter, “person”) was arrested on Friday, July 14, 2001. The crime for which the person was arraigned (hereinafter, “appeal”) was: The crime for which the person was arraigned (hereinafter, “appeal”) was one of the following crimes: The crime for which the person was charged (hereinafter, “charge”) was one of the following crimes: ... (Sections 4, 53-54, 54-107, 113, 114, 117 for summary offenses) Section 54A-639 of the Michigan Compiled Law, Sections 5-108 and 5-11.
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