State of Delaware
BOARD OF PARDONS
DELAWARE BOARD OF PARDONS CHECKLIST
YOU MUST COMPLETE STEPS 1 AND 2 BEFORE PROCEEDING WITH THE APPLICATION PROCESS. THESE TWO STEPS WILL TAKE SEVERAL WEEKS! ALL APPLICATIONS MUST BE FILLED IN ONLINE AND THEN PRINTED FOR SUBMISSION.
Step 1
Request your Certified Criminal History which can be obtained by submitting a fee along with your fingerprints to State Bureau of Identification. For specific information and locations please contact them at (302) 739-5871. Please be advised that your Criminal History Report cannot be older than 3 months at the time your application is submitted. This document must be attached to your application.
Step 2
Request Certified Court Dockets and Sentencing Orders and/or Disposition Records for all ADULT dispositions listed as guilty, unknown, unobtainable, transferred or pending. Additionally, you must submit certified copies of financial information on outstanding fines, costs, fees and restitution. Contact the courts in the county associated
with the offense(s) for further information on how to request the documents. These documents must be attached to
your application.
Step 3
Once you have received your Certified Criminal History and your Certified Court Dockets and Sentencing Orders, complete the page titled “Criminal History Review Form”.
Step 4
Compare your offense(s) from your “Criminal History Review Form” to the offense(s) listed on the “Offenses that
Require a Mental Health Report.” If jail time was served in relation to an offense(s) that require a mental health report,
you will have to provide a Psychiatric or Psychological Evaluation from a licensed professional of your choice. Any psychologist or psychiatrist performing an evaluation must submit the information requested in Rule 9, paragraph (c) listed on page 12 of the Rules of the Board of Pardons.
Step 5
Complete the entire Delaware Board of Pardons Application for Pardon by typing in your responses online and then printing all forms once complete.
Step 6
Complete the Affidavit of Mailing by typing in your responses online and then printing once complete. This form must be notarized. Include the original Affidavit in your application and mail copies to the individuals listed on the form.
Step 7
To request a Telephonic hearing due to hardship, please complete and submit the Hardship Form with the application. Please be aware that this request is subject to approval.
Step 8
Assemble all your documents to include the criminal history report and the court dockets and attach them to the appropriate sections as specified in the application. Once assembled, make one copy of EVERYTHING (so you will have a total of 2 complete packets). Use a paper clip or binder clip to attach your documents together for each packet. Stapled
documents will not be accepted.
Step 9
Keep one copy of your application packet for your records and mail the original packet to:
Board of Pardons
Secretary of State’s Office
401 Federal Street, Suite 3
DOVER, DE 19901
If you have any questions, contact the Board of Pardons at 302-739-4111, option 2. You can also visit us online at
pardons.delaware.gov.
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Ｐｄｎｈ＃ｖｘｕｈ＃ｗｋｄｗ＃ｄｏｏ＃ｒｉ＃ｗｋｈ＃ｒｉｉｈｑｖｈｖ＃ｕｈｔｘｌｕｈｇ＃ｗｒ＃ｅｈ＃ｄｇｇｕｈｖｖｈｇ＃ｌｑ＃ｗｋｌｖ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｄｕｈ＃ ｏｌｖｗｈｇ１＃ Ｉｄｌｏｘｕｈ＃ｗｒ＃ｏｌｖｗ＃ｄｏｏ＃ｕｈｔｘｌｕｈｇ＃ｆｋｄｕｊｈｖ＃ｚｌｏｏ＃ｕｈｖｘｏｗ＃ｌｑ＃｜ｒｘｕ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｅｈｌｑｊ＃
ｕｈｗｘｕｑｈｇ１＃ Ｗｋｌｖ＃ｏｌｖｗ＃ｚｌｏｏ＃ｖｈｕｙｈ＃ｄｖ＃ｄ＃ｊｘｌｇｈ＃ｄｖ＃｜ｒｘ＃ｆｒｐｓｏｈｗｈ＃ｗｋｈ＃ＧＨＯＤＺＤＵＨ＃ＥＲＤＵＧ＃
ＲＩ＃ＳＤＵＧＲＱＶ＃ＤＳＳＯＬＦＤＷＬＲＱ
＃
ＧＨＯＤＺＤＵＨ＃ＥＲＤＵＧ＃ＲＩ＃ＳＤＵＧＲＱＶ＃＃
ＤＳＳＯＬＦＤＷＬＲＱ＃ＩＲＵ＃ＳＤＵＧＲＱ
＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃ＦＲＹＨＵ＃ＶＫＨＨＷ＃ ＃
＃
＃＃＃＃＃ |
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４１ |
Ｉｘｏｏ＃ｑｄｐｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂ＃ |
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Ｉｌｕｖｗ＃＃＃＃＃＃＃＃ ＃ |
＃ |
＃Ｐｌｇｇｏｈ＃ |
＃ |
Ｏｄｖｗ＃＃＃＃＃＃＃＃＃＃ |
＃Ｖｘｉｉｌ｛＃ |
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５１＃ ＃＃Ｄｇｇｕｈｖｖ＝＃ｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ｂｂｂｂｂｂ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
Ｑｘｐｅｈｕ＃ |
＃ |
Ｖｗｕｈｈｗ＃ ＃ |
＃ |
Ｆｌｗ｜＃ |
Ｖｗｄｗｈ＃ |
］ｌｓ＃Ｆｒｇｈ＃ |
＃＃
６１＃ ＃＃Ｗｈｏｈｓｋｒｑｈ＃Ｑｘｐｅｈｕ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂＶＥＬ＃Ｑｒ１＃
＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＋Ｌｑｆｏｘｇｈ＃ｄｕｈｄ＃ｆｒｇｈ，＃＃ ＃ ＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＋Ｏｒｆｄｗｈｇ＃ｒｑ＃｜ｒｘｕ＃Ｆｕｌｐｌｑｄｏ＃Ｋｌｖｗｒｕ｜，＃
＃
７１＃ ＃＃Ｈｐｄｌｏ＃Ｄｇｇｕｈｖｖ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
＃ |
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８１＃ ＃＃Ｇｄｗｈ＃ｒｉ＃ｅｌｕｗｋ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
Ｐｄｏｈ＃＃＃＃＃＃＃＃＃＃＃＃＃ Ｉｈｐｄｏｈ＃ |
＃ |
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９１＃ ＃＃Ｖｗｄｗｈ＃ｈｙｈｕ｜＃ｒｗｋｈｕ＃ｑｄｐｈ＃ｅ｜＃ｚｋｌｆｋ＃｜ｒｘ＃ｋｄｙｈ＃ｅｈｈｑ＃ｎｑｒｚｑ／＃ｌｑｆｏｘｇｌｑｊ＃ｗｋｈ＃ｑｄｐｈ＃ｘｑｇｈｕ＃ｚｋｌｆｋ＃｜ｒｘ＃
＃＃＃＃＃＃＃ｚｈｕｈ＃ｆｒｑｙｌｆｗｈｇ＃＋I.E.／＃ｌｑｆｏｘｇｈ＃｜ｒｘｕ＃ｐｄｌｇｈｑ＃ｑｄｐｈ／＃ｑｄｐｈ＃ｅ｜＃ｄ＃ｉｒｕｐｈｕ＃ｐｄｕｕｌｄｊｈ／＃ｄｏｌｄｖｈｖ／＃ｄｑｇ＃＃
ｑｌｆｎｑｄｐｈｖ，１＃
＃
＃＃＃＃＃＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃
：１＃Ｄｗｗｒｕｑｈ｜＃Ｌｑｉｒｕｐｄｗｌｒｑ＃ﾱ＃Ｄｕｈ＃｜ｒｘ＃ｕｈｓｕｈｖｈｑｗｌｑｊ＃｜ｒｘｕｖｈｏｉＢ＃＃
＃
＼ｈｖ＃＃＃＃ Ｑｒ／＃ｌｉ＃ｑｒ＃｜ｒｘ＃ｐｘｖｗ＃ｓｕｒｙｌｇｈ＃｜ｒｘｕ＃ｄｗｗｒｕｑｈ｜ﾶｖ＃ｌｑｉｒｕｐｄｗｌｒｑ１＃Ｒｗｋｈｕｚｌｖｈ／＃ｓｕｒｆｈｈｇ＃ｗｒ＃ｗｋｈ＃ｑｈ｛ｗ＃ｖｗｈｓ１＃＃
＃
Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｑｄｐｈ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃
Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｄｇｇｕｈｖｖ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃
Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｓｋｒｑｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃
Ｄｗｗｒｕｑｈ｜ﾶｖ＃Ｈｐｄｌｏ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃
ＱＲＷＨ＝＃Ｓｏｈｄｖｈ＃ｆｒｑｗｄｆｗ＃ｗｋｈ＃Ｅｒｄｕｇ＃ｒｉ＃Ｓｄｕｇｒｑｖ＃＋６３５０：６＜０７４４４／＃ｒｓｗｌｒｑ＃５，＃ ｌｐｐｈｇｌｄｗｈｏ｜＃ｌｉ＃ｗｋｈｕｈ＃ｌｖ＃ｄ＃ｆｋｄｑｊｈ＃
ｒｉ＃ｄｇｇｕｈｖｖ＃ｖｌｑｆｈ＃ｗｋｌｖ＃ｚｌｏｏ＃ｄｉｉｈｆｗ＃｜ｒｘｕ＃ｅｈｌｑｊ＃ｑｒｗｌｉｌｈｇ＃ｒｉ＃ｄ＃ｋｈｄｕｌｑｊ＃ｇｄｗｈ＃ｒｕ＃ｕｈｆｈｌｙｌｑｊ＃ｄｑ｜＃ｒｗｋｈｕ＃ｆｒｕｕｈｖｓｒｑｇｈｑｆｈ１＃
Ｄｗｗｄｆｋ＃Ｆｕｌｐｌｑｄｏ＃Ｋｌｖｗｒｕ｜＃Ｕｈｓｒｕｗ＃ｄｑｇ＃Ｆｕｌｐｌｑｄｏ＃Ｋｌｖｗｒｕ｜＃Ｕｈｙｌｈｚ＃Ｉｒｕｐ＃
＃
ＥＬＲＪＵＤＳＫＬＦＤＯ＃ＬＱＩＲＵＰＤＷＬＲＱ＃＃＃
＃
＃Ｚｋｄｗ＃ｌｖ＃｜ｒｘｕ＃ｋｌｊｋｈｖｗ＃ｏｈｙｈｏ＃ｒｉ＃ｈｇｘｆｄｗｌｒｑＢ＃
＃
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃Ｄｑ｜＃ｎｑｒｚｑ＃ｏｈｄｕｑｌｑｊ＃ｇｌｖｄｅｌｏｌｗｌｈｖＢ＃＃＃＃＼ｈｖ＃ ＃Ｑｒ１＃ Ｌｉ＃｜ｈｖ／＃ｅｕｌｈｉｏ｜＃ｇｈｖｆｕｌｅｈ１＃＃
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Ｑｒ１＃Ｌｉ＃｜ｈｖ／＃ｅｕｌｈｉｏ｜＃ｇｈｖｆｕｌｅｈ＃ｗｕｈｄｗｐｈｑｗ１＃ |
Ｄｑ｜＃ｋｌｖｗｒｕ｜＃ｒｉ＃ｐｈｑｗｄｏ＃ｋｈｄｏｗｋ＃ｌｖｖｘｈｖＢ＃ |
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＃Ｄｑ｜＃ｋｌｖｗｒｕ｜＃ｒｉ＃ｖｘｅｖｗｄｑｆｈ２ｄｏｆｒｋｒｏ＃ｄｅｘｖｈＢ＃ ＃ ＃＼ｈｖ＃ ＃Ｑｒ１＃Ｌｉ＃｜ｈｖ／＃ｅｕｌｈｉｏ｜＃ｇｈｖｆｕｌｅｈ＃ｇｕｘｊ２ｖｘｅｖｗｄｑｆｈ＃ｒｉ＃ｆｋｒｌｆｈ＃ｄｑｇ＃ ｚｋｈｑ＃ｄｇｇｌｆｗｌｒｑ＃ｅｈｊｄｑ１＃
＃
＃Ｚｋｄｗ＃ｌｖ＃｜ｒｘｕ＃ｆｘｕｕｈｑｗ＃ｐｄｕｌｗｄｏ＃ｖｗｄｗｘｖＢ＃
＃＋Ｆｋｈｆｎ＃ｒｑｈ＝，＃ Ｖｌｑｊｏｈ＃＃＃＃＃＃＃＃＃＃＃＃＃＃Ｐｄｕｕｌｈｇ＃ｒｕ＃Ｈｑｗｈｕｈｇ＃ｌｑｗｒ＃ｄ＃Ｆｌｙｌｏ＃Ｘｑｌｒｑ＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃Ｇｌｙｒｕｆｈｇ＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃Ｚｌｇｒｚｈｇ＃
Ｇ＃ ｒ＃｜ｒｘ＃ｋｄｙｈ＃ｆｋｌｏｇｕｈｑ＃ｒｕ＃ｒｗｋｈｕ＃ｇｈｓｈｑｇｈｑｗｖＢ＃ ＃＃＃＃＃＼ｈｖ＃ Ｑｒ＃
Ｌｉ＃｜ｈｖ／＃ｇｈｖｆｕｌｅｈ＃ｗｋｈｐ１＃＋Ｈ｛ｄｐｓｏｈ＝＃ｑｄｐｈ／＃ｄｊｈ＃ｄｑｇ＃ｏｌｙｌｑｊ＃ｄｕｕｄｑｊｈｐｈｑｗ，＃
＃
Ｆ＃ ｘｕｕｈｑｗ＃Ｈｐｓｏｒ｜ｐｈｑｗ＃Ｖｗｄｗｘｖ／＃ｌｉ＃ｑｒｗ＃ｈｐｓｏｒ｜ｈｇ＃ｖｗｄｗｈ＃ｗｋｈ＃ｕｈｄｖｒｑｖＢ＃＃
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Ｄ＃ ｕｈ＃｜ｒｘ＃ｆｘｕｕｈｑｗｏ｜＃ｈｑｕｒｏｏｈｇ＃ｌｑ＃ｖｆｋｒｒｏ２ｙｒｆｄｗｌｒｑｄｏ＃ｗｕｄｌｑｌｑｊ／＃ｌｉ＃｜ｈｖ／＃ｓｕｒｙｌｇｈ＃ｗｋｈ＃ｑｄｐｈ＃ｄｑｇ＃ｏｒｆｄｗｌｒｑ＃ｄｑｇ＃｜ｒｘｕ＃ｄｕｈｄ＃ ｒｉ＃ｖｗｘｇ｜Ｂ＃
ＶＸＰＰＤＵ＼＃ＲＩ＃ＲＩＩＨＱＶＨ＋Ｖ，＃
＃
Ｉｌｏｏ＃ｒｘｗ＃ｄ＃ｖｈｓｄｕｄｗｈ＃ｆｒｓ｜＃ｒｉ＃ｗｋｌｖ＃ｓｄｊｈ＃ｉｒｕ＃ｈｄｆｋ＃ｆｒｑｙ＃ｌｆｗｌｒｑ that is listed on the Criminal History Review Form１＃ Ｓｕｒｙｌｇｈ＃ｕｈｔｘｈｖｗｈｇ＃ｌｑｉｒｕｐｄｗｌｒｑ＃ｉｒｕ＃ｒｉｉｈｑｖｈ＋ｖ，＃ｚｋｌｆｋ＃ｆｄｑ＃ｅｈ＃ｉｒｘｑｇ＃ｒｑ＃ｗｋｈ＃ｆｒｘｕｗ＃ｇｒｆｎｈｗ＃ｄｑｇ＃ｖｈｑｗｈｑｆｌｑｊ＃ｒｕｇｈｕ１＃＃
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＃＃＃＃＃ |
Ｄｕｕｈｖｗ＃Ｇｄｗｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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Ｒｉｉｈｑｖｈ＋ｖ，＝＃Ｌｉ＃ｐｒｕｈ＃ｗｋｄｑ＃ｒｑｈ＃ｒｉｉｈｑｖｈ＃ｚｄｖ＃ｄｖｖｒｆｌｄｗｈｇ＃ｚｌｗｋ＃ｗｋｈ＃ｖｄｐｈ＃ｄｕｕｈｖｗ／＃ｏｌｖｗ＃ｗｋｈｐ１＃ |
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Ｖ＃ ｈｑｗｈｑｆｈ＃Ｇｄｗｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ Ｖｈｑｗｈｑｆｈ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
Ｋｒｚ＃ｐｘｆｋ＃ｗｌｐｈ／＃ｌｉ＃ｄｑ｜／＃ｇｌｇ＃｜ｒｘ＃ｖｈｕｙｈ＃ｌｑ＃ｄ＃ｆｒｕｕｈｆｗｌｒｑｄｏ＃ｉｄｆｌｏｌｗ｜＃ｉｒｕ＃ｗｋｌｖ＃ｒｉｉｈｑｖｈＢ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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＃ＧＧｌｇ＃｜ｒｘ＃ｖｈｕｙｈ＃ｗｌｐｈ＃ｌｑ＃ｄ＃ｆｒｕｕｈｆｗｌｒｑｄｏ＃ｉｄｆｌｏｌｗ｜＃ｉｒｕ＃ｗｋｌｖ＃ｒｉｉｈｑｖｈ＃ｄｑｇ＃ｌｉ＃ｖｒ＃ｋｒｚ＃ｐｘｆｋ＃ｗｌｐｈ＃ｚｄｖ＃ｖｈｕｙｈｇｌｇ＃｜ｒｘ＃ｖｈｕｙｈ＃ｗｌｐｈ |
Ｓｕｒｅｄｗｌｒｑ＝＃ |
＃＼ｈｖ＃ |
＃Ｑｒ＃ |
＃＃＃ |
Ｌｉ＃｜ｈｖ／＃ｓｕｒｙｌｇｈ＃ｇｄｗｈ＃ｆｒｐｓｏｈｗｈｇ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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Ｕｈｖｗｌｗｘｗｌｒｑ＝＃＃ |
＃＼ｈｖ＃ |
＃ |
Ｑｒ＃ |
＃＃ |
Ｌｉ＃｜ｈｖ／＃ｄｐｒｘｑｗ＃ｄｑｇ＃ｌｉ＃ｒｅｏｌｊｄｗｌｒｑ＃ｌｖ＃ｕｈｖｒｏｙｈｇ＃＋ｓｄｌｇ，＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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＃＋Ｌｉ＃ｒｅｏｌｊｄｗｌｒｑ＃ｌｖ＃ｑｒｗ＃ｕｈｖｒｏｙｈｇ／＃ｓｏｈｄｖｈ＃ｆｒｑｗｄｆｗ＃ｗｋｈ＃ｆｒｘｕｗ＃ｄｑｇ＃ｕｈｔｘｈｖｗ＃ｄ＃ｆｌｙｌｏ＃ｍｘｇｊｐｈｑｗ＃ｄｑｇ＃ｄｗｗｄｆｋ＃ｌｗ＃ｗｒ＃ｗｋｌｖ＃ｓｄｊｈ，＃ |
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Ｑｄｐｈ＃ｒｉ＃Ｆｒｘｕｗ＝＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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Ｆｒｘｕｗ＃Ｄｇｇｕｈｖｖ＝＃ｂｂｂｂｂｂｂｂ＃＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃ｂｂｂｂｂｂｂｂｂｂｂ＃＃ｂｂｂｂｂｂｂｂ＃＃ｂｂｂｂｂｂｂｂｂ＃ |
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］ｌｓ＃Ｆｒｇｈ＃ |
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＃＃＃＃＃＃＃＃＃＃＃＃Ｑ＃＃＃ｄ＃＃ｕ＃＃ｕ＃＃ｄ＃＃ｗ＃ｌ＃ｙ＃＃ｈ＃＃＃Ｇｈｖｆｕｌｓｗｌｒｑ＃ｒｉ＃ｗｋｈ＃Ｒｉｉｈｑｖｈ＋ｖ，＝＃Ｓｕｒｙｌｇｈ＃ｄ＃ｆｒｐｓｏｈｗｈ＃ｄｑｇ＃ｇｈｗｄｌｏｈｇ＃ｄｆｆｒｘｑｗ＃ｒｉ＃ｗｋｈ＃ｒｉｉｈｑｖｈ＃＃＋ｖ，＃｜＃ｒ＃＃ｘ＃ｏｌｖｗｈｇ＃
C C
＃ ｄｅｒｙｈ１＃＼ｒｘ＃ｄｕｈ＃ｈ｛ｓｈｆｗｈｇ＃ｗｒ＃ｇｈｖｆｕｌｅｈ＃ｌｑ＃｜ｒｘｕ＃ｒｚｑ＃ｚｒｕｇｖ＃ｗｋｈ＃ｉｄｆｗｘｄｏ＃ｇｈｗｄｌｏｖ＃ｖｘｕｕｒｘｑｇｌｑｊ＃ｗｋｈ＃ｒｉｉｈｑｖｈ＋ｖ，１＃Ｇｈｖｆｕｌｅｈ＃ ｗｋｈ＃ ｉｘｏｏ＃ｈ｛ｗｈｑｗ＃ｒｉ＃｜ｒｘｕ＃ｌｑｙｒｏｙｈｐｈｑｗ＃ｌｑ＃ｗｋｈ＃ｆｕｌｐｌｑｄｏ＃ｆｒｑｇｘｆｗ１＃
＃
＃＃＃＃＃＃
＃＃Ｄｗｗｄｆｋ＃ｗｋｈ＃Ｆｈｕｗｌｉｌｈｇ＃Ｆｒｘｕｗ＃Ｇｒｆｎｈｗ＋ｖ，＃ｄｑｇ＃Ｖｈｑｗｈｑｆｌｑｊ＃Ｒｕｇｈｕ＋ｖ，＃ｄｖｖｒｆｌｄｗｈｇ＃ｚｌｗｋ＃ｗｋｈ＃ｒｉｉｈｑｖｈ＋ｖ，＃
REASONS FOR SEEKING A PARDON
What are your reasons for seeking a pardon? Attach any supporting documents as evidence to support reasons due to extenuating circumstances. (Example: Denial letter due to failed background check or written regulations regarding criminal convictions preventing you from services)
Pending Proceedings: Do you have pending any judicial or administrative proceedings with the federal, state, or local governments? Yes No. If yes, state the full jurisdiction in which the proceeding is pending, the nature of the dispute, and the current status of the matter.
Describe below any community/charitable activities you are involved in and your duties. (You may attach any certificates or documents)
References may be attached to this page
Attach supporting documents as evidence to support reasons due to extenuating circumstances.
＃
ＤＩＩＬＧＤＹＬＷ＃ＲＩ＃ＰＤＬＯＬＱＪ＃
＃
＃
ＶＷＤＷＨ ＲＩ ＧＨＯＤＺＤＵＨ
ＧＨＯＤＺＤＵＨ＃ＥＲＤＵＧ＃ＲＩ＃ＳＤＵＧＲＱＶ＃
＃
＃Ｄｓｓｏｌｆｄｑｗ＃Ｑｄｐｈ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂＧｄｗｈ＃ｒｉ＃Ｅｌｕｗｋ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃
＃
＃Ｗｋｈ＃ｄｅｒｙｈ＃ｄｓｓｏｌｆｄｑｗ＃ｋｄｖ＃ｉｌｏｈｇ＃ｄ＃ｓｈｗｌｗｌｒｑ＃ｉｒｕ＃ｄ＃ｓｄｕｇｒｑ＃ｚｌｗｋ＃ｗｋｈ＃Ｅｒｄｕｇ＃ｒｉ＃Ｓｄｕｇｒｑｖ＃＋ﾳＥｒｄｕｇﾴ，＃ｌｑ＃ｗｋｈ＃Ｖｈｆｕｈｗｄｕ｜＃ ｒｉ＃Ｖｗｄｗｈﾶｖ＃Ｒｉｉｌｆｈ／＃７３４＃Ｉｈｇｈｕｄｏ＃Ｖｗｕｈｈｗ／＃Ｖｘｌｗｈ＃６／＃Ｇｒｙｈｕ／＃ＧＨ＃４＜＜３４１＃Ｗｋｈ＃ｓｈｗｌｗｌｒｑ＃ｚｌｏｏ＃ ｅｈ＃ｋｈｄｕｇ＃ｄｗ＃ｗｋｈ＃ｈｄｕｏｌｈｖｗ＃
＃ｓｒｖｖｌｅｏｈ＃ｇｄｗｈ＃ｄｖ＃ｇｈｗｈｕｐｌｑｈｇ＃ｅ｜＃ｗｋｈ＃Ｅｒｄｕｇ１＃ Ｋｈｄｕｌｑｊｖ＃ｄｕｈ＃ｋｈｏｇ＃ｄｗ＃ｗｋｈ＃Ｎｈｑｗ＃Ｆｒｘｑｗ｜＃Ｆｒｘｕｗｋｒｘｖｈ／＃Ｆｒｘｕｗｕｒｒｐ＃；／＃ ７４７＃Ｉｈｇｈｕｄｏ＃Ｖｗｕｈｈｗ／＃Ｇｒｙｈｕ／＃ＧＨ＃ ４＜＜３４１＃
Ｆｒｓｌｈｖ＃ｒｉ＃ｗｋｌｖ＃ｄｉｉｌｇｄｙｌｗ＃ｒｉ＃ｐｄｌｏｌｑｊ＃ｋｄ＃ｙｈ＃ｅｈｈｑ＃ｖｈｑｗ＃ｗｒ＝＃
４１＃ Ｗｋｈ＃Ｍｘｇｊｈ＋ｖ，＃ｚｋｒ＃ｓｕｈｖｌｇｈｇ＃ｄｗ＃ｗｋｈ＃ｖｈｑｗｈｑｆｌｑｊ＃ｋｈｄｕｌｑｊ＋ｖ，＃ｒｕ＃Ｓｕｈｖｌｇｌｑｊ＃Ｍｘｇｊｈ＋ｖ，＃
＃５１＃ Ｍｒｖｈｓｋ＃Ｕ１＃Ｅｌｇｈｑ／＃ＬＬＬ／＃Ｈｖｔ１＃Ｄｗｗｒｕｑｈ｜＃Ｊｈｑｈｕｄｏ／＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｍｘｖｗｌｆｈ／＃Ｆｄｕｙｈｏ＃Ｖｗｄｗｈ＃Ｅｘｌｏｇｌｑｊ／＃；５３＃Ｑ１＃Ｉｕｈｑｆｋ＃Ｖｗ１／＃
Ｚｌｏｐｌｑｊｗｒｑ／＃ＧＨ＃ ４＜；３４１＃
６１＃ Ｆｋｌｈｉ＃ｒｉ＃Ｓｒｏｌｆｈ＃ｌｑ＃ｗｋｈ＃ｆｌｗ｜２ｆｒｘｑｗ｜＃ｚｋｈｕｈ＃ｗｋｈ＃ｄｕｕｈｖｗ＋ｖ，＃ｚｄｖ２ｚｈｕｈ＃ｐｄｇｈ１＃＃Ｒｐｌｗ＃ｗｋｌｖ＃ｖｗｈｓ＃ｌｉ＃｜ｒｘ＃ｚｈｕｈ＃ｒｑｏ｜＃
ｄｕｕｈｖｗｈｇ＃ｅ｜＃Ｇｈｏｄｚｄｕｈ＃Ｖｗｄｗｈ＃Ｓｒｏｌｆｈ１＃
７１＃ Ｆｒｏｒｑｈｏ＃Ｑｄｗｋｄｑｌｈｏ＃ＰｆＴｘｈｈｑ／＃Ｖｘｓｈｕｌｑｗｈｑｇｈｑｗ／＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｓｘｅｏｌｆ＃Ｖｄｉｈｗ｜／＃Ｇｌｙｌｖｌｒｑ＃ｒｉ＃Ｖｗｄｗｈ＃Ｓｒｏｌｆｈ／＃
＃＃＃＃＃＃Ｓ１Ｒ１＃Ｅｒ｛＃７６３／＃Ｇｒｙｈｕ／＃ＧＨ＃ ４＜＜３６１＃ Ｕｈｄｖｒｑ＋ｖ，＃ｉｒｕ＃ｄｓｓｏ｜ｌｑｊ＝＃
＃
＃
Ｒｉｉｈｑｖｈ＋ｖ，＃ｄｑｇ＃Ｇｄｗｈ＋ｖ，＃ｒｉ＃Ｄｕｕｈｖｗ＝＃
＃＃＃＃＃＃＃＃＃＃＃＃
＃
＃
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃ |
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃ |
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＃＃＃＃＃ |
＃＃＃＃ |
＃ |
＃ |
Ｖｌｊｑｄｗｘｕｈ＃ｒｉ＃Ｄｓｓｏｌｆｄｑｗ＃ |
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Ｇｄｗｈ＃ |
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＃
ＶＷＤＷＨ＃ＲＩ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃＃，＃
＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃，＃＃＃＃ＶＶ＃ ＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃＃
ＦＲＸＱＷ＼＃ＲＩ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃＃＃，＃
＃
Ｗｋｌｖ＃ｄｓｓｏｌｆｄｑｗ／＃ｅｈｌｑｊ＃ｖｚｒｕｑ／＃ｇｈｓｒｖｈｖ＃ｄｑｇ＃ｖｄ｜ｖ＃ｗｋｄｗ＃ｋｈ２ｖｋｈ＃ｌｖ＃ｄｗｗｈｖｗｌｑｊ＃ｗｋｄｗ＃ｄｏｏ＃ｖｗｄｗｈｐｈｑｗｖ＃ｆｒｑｗｄｌｑｈｇ＃ｌｑ＃ｋｌｖ２ｋｈｕ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｄｕｈ＃ｗｕｘｈ＃ ｄｑｇ＃ｆｒｕｕｈｆｗ＃ｌｑ＃ｈｙｈｕ｜＃ｕｈｖｓｈｆｗ／＃ｄｑｇ＃ｗｋｄｗ＃ｋｈ２ｖｋｈ＃ｋｄｖ＃ｑｒｗ＃ｖｘｓｓｕｈｖｖｈｇ＃ｄｑ｜＃ｌｑｉｒｕｐｄｗｌｒｑ＃ｗｋｄｗ＃ｐｌｊｋｗ＃ｄｉｉｈｆｗ＃ｗｋｌｖ＃ｄｓｓｏｌｆｄｗｌｒｑ１＃
＃
Ｖｚｒｕｑ＃ｗｒ＃ｐｈ＃ｅｈｉｒｕｈ＃ｐｈ＃ｗｋｌｖ＃ｂｂｂｂｂｂ＃ｇｄ｜＃ｒｉ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ／＃５３＃ｂｂｂｂｂｂｂｂｂｂ１＃
＃
ｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂｂ＃＃＃＃＃
＃＃＃＃＃＃＃＃＃＃Ｖｌｊｑｄｗｘｕｈ＃ｒｉ＃Ｑｒｗｄｕ｜＃Ｓｘｅｏｌｆ＃
＃
Ｐ｜＃ｆｒｐｐｌｖｖｌｒｑ＃ｈ｛ｓｌｕｈｖ＃ｂｂｂｂｂｂｂｂｂｂｂｂｂｂ１＃＃＃＋ＶＨＤＯ，＃
＃ＬＰＳＲＵＷＤＱＷ＝＃Ｐｄｎｈ＃ｖｘｕｈ＃｜ｒｘ＃ｋｄｙｈ＃ｆｒｐｓｏｈｗｈｇ＃ｈｙｈｕ｜＃ｌｗｈｐ＃ｒｑ＃ｗｋｈ＃ｆｋｈｆｎｏｌｖｗ＃ｄｑｇ＃ｗｋｄｗ＃｜ｒｘｕ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｌｖ＃ｖｌｊｑｈｇ＃ｄｑｇ＃ｆｒｐｓｏｈｗｈ１ Ｄｑ｜＃ｐｌｖｖｌｑｊ＃ｌｑｉｒｕｐｄｗｌｒｑ＃ｚｌｏｏ＃ｖｌｊｑｌｉｌｆｄｑｗｏ｜＃ｇｈｏｄ｜＃ｓｕｒｆｈｖｖｌｑｊ１＃
REQUEST FOR A TELEPHONIC HEARING DUE TO HARDSHIP
Due to the circumstance(s) described below, the applicant is requesting that a telephonic hearing be allowed in place of a “personal appearance”.
Applicant Name _______________________________________ Date of Birth ___________________
Reason(s) petitioner has found that it would be a hardship to physically attend the hearing:
_________________________________________________________________________________
If an approval of hardship is made, the “Board” may require that you be available by phone at your scheduled time. Please provide a reliable telephone number that could be used to contact you for a possible telephonic hearing (___________)-__________________________________.
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____________________________ |
Signature of Applicant |
Date |
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___________________________ |
Approved |
Date |
