Dpca 52 Form PDF Details

The journey toward rehabilitation and societal reintegration for individuals with past criminal convictions is fraught with challenges, notably the automatic legal and social barriers to employment and other rights. Within the State of New York, a significant tool exists to aid in this process: the Application for Certificate of Relief from Disabilities, formally known as the DPCA 52 form. This document serves as a linchpin for eligible offenders, aiming to mitigate the aftermath of their convictions by potentially relieving them of various legal forfeitures, employment barriers, and other disabilities that are automatically imposed by their criminal records. By completing this application, individuals seek not only to overcome these hurdles but also to secure a formal reassurance that can facilitate their efforts toward employment, among other rights—with the explicit exception of eligibility for public office. It's vital to understand that this certificate does not equate to a pardon but rather provides a means to ease certain restrictions tied to the individual’s past offense, as specified within the form. The intricate requirements, including a thorough investigation of the applicant's suitability and the necessity of a notarized signature, underscore the form's seriousness and the significant impact it holds for the applicant's future. Moreover, the certificate, once issued, is classified as either permanent or temporary—depending on specific conditions outlined by the issuing court or parole board, highlighting the nuanced approach New York State takes in balancing the scales of justice and rehabilitation.

QuestionAnswer
Form NameDpca 52 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescertificate disabilities shall online, certificate court relieve, dpca relief disabilities, disabilities relieve relief

Form Preview Example

STATE OF NEW YORK

APPLICATION BY AN ELIGIBLE OFFENDER FOR CERTIFICATE OF RELIEF FROM DISABILITIES

FOR COU RT OR BOA RD OF PA ROLE Docket, File or other Identifier

1. A pplicant's Last N am e

First N am e

Initial

3. N YSID (if know n)

2. A ddress (Street and House N um ber, City, State, ZIP)

4.

 

Sex

 

 

5. Race

6.

H eight

 

7. Date of Birth (M onth/Day/Year)

 

 

 

M ale

 

Fem ale

 

 

Ft

In.

 

 

 

 

 

 

 

 

8.

 

Offense for w hich convicted

9.

Date of arrest

10. Date of sentence

11. Court of Disposition (Court, Part, Term , Venue)

12. Certificate issued by:

 

 

 

 

 

 

 

 

 

 

 

Court indicated in box 11

 

 

 

 

 

 

 

 

 

 

State Board of Parole

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

Certificate is intended to replace an existing certificate,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

issued on:

 

 

 

 

 

 

 

 

 

 

 

 

N ot applicable

 

14. A pplication is hereby m ade for a grant of a Certificate of Relief from D isabilities w hich w ill

 

 

a. relieve the holder of all forfeitures, and of all disabilities and bars to em ploym ent, excluding the right to retain

 

 

 

 

 

or to be eligible for public office, by virtue of the fact that the certificate is issued at the tim e of sentence.

 

 

b.

relieve the holder of all disabilities and bars to em ploym ent, excluding the right to be eligible for public office.

 

 

c.

relieve the holder of the forfeitures, disabilities or bars to em ploym ent hereinafter enumerated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. The applicant agrees to allow an investigation to be m ade to determ ine his or her fitness for a certificate of relief from disabilities, pursuant to Correction Law A rticle 23.

 

A pplicant’s Signature

Date

 

 

sign in the presence of a notary

16.

State of N ew York )

 

ss.:

County of _________ )

____________________________________, being duly sw orn, deposes and says that __ he is the applicant nam ed in

the w ithin application; that __he has read the foregoing application and know s the contents thereof; that the sam e is true to h____ ow n know ledge, except as to the m atters therein stated to be alleged on inform ation and belief,

and that as to those matters __he believes it to be true.

Sw orn to before m e this _____ day of _____________ 20___

_________________________________

N otary Public affix stamp / seal

DC- DPCA-52 (6-05)

STATE OF NEW YORK

CERTIFICATE OF RELIEF FROM DISABILITIES

FOR COU RT OR BOA RD OF PA ROLE Docket, File or other Identifier

This certificate is issued to the holder from all or certain enum erated disabilities, forfeitures, or bars to his employm ent autom atically im posed by law by reason of his conviction of the crim e or of the offense specified herein.

T his certificate sh all N O T be d eem ed nor con stru cted to b e a p ard on .

See reverse side for explanation of the law governing this certificate, or http://courts.state.ny.us/courts/10jd/suffolk/dist/RCD.shtml

The original certificate is to be presented to the person to whom awarded. One copy is to be retained by the issuing agency, and one copy is to be filed with the NYS Division of Criminal Justice Services, 4 Tower Place, Albany, NY 12203-3702

1.

Used by DCJS

Holder of Certificate

 

 

3. NYSID

 

 

 

 

 

 

2. Last N am e, First N am e, Initial

 

 

 

 

 

 

 

 

 

 

 

 

( i f u n k n o w n , s u p p l y

 

 

 

 

 

 

 

fingerprints to DCJS. If

 

 

 

 

 

 

 

fingerprints are unobtainable,

 

 

 

 

 

 

 

complete 15-18 below)

4.

Crim e or Offense for w hich convicted

5.

Date of arrest

6.

Date of sentence

7.

Court of Disposition

 

 

 

8.

Certificate issued by:

 

(Court, Part, Term , Venue)

 

 

 

 

 

Court indicated in box 7

 

 

 

 

 

 

 

State Board of Parole

 

 

 

 

 

 

 

9.

Date this certificate issued

10.

 

Certificate replaces an existing Certificate of Relief from

 

 

 

 

Disabilities, previously issued on:

 

 

 

 

N ot applicable

 

 

 

 

 

 

 

 

 

 

11. This certificate shall

a. relieve the holder of all forfeitures, and of all disabilities and bars to em ploym ent, excluding the right to retain or to be eligible for public office, by virtue of the fact that the certificate is issued at the tim e of sentence.

b. relieve the holder of all disabilities and bars to em ploym ent, excluding the right to be eligible for public office.

c. relieve the holder of the forfeitures, disabilities or bars hereinafter enumerated

12. “

This certificate shall be considered perm anent.

 

“ This certificate shall be considered tem porary until

. A fter this date, unless revoked

 

earlier by issuing court or parole board, this certificate shall be considered perm anent. A person w ho

know ingly uses or attem pts

to use a revoked certificate in order to obtain or exercise any right or privilege that

he/she would not be entitled to obtain or to exercise w ithout valid certificate shall be guilty of a m isdem eanor.

13.

14.

 

 

 

 

Signature of issuing official

Name of issuing official

title of issuing official

15. Sex

 

16. Race

17. Height

 

18. Date of Birth (Month/Day/Year)

 

 

Male

 

Female

Ft

In.

 

 

 

 

 

DC- DPCA-53 (6/05) Proposed Certificate submitted with DC- DPCA-52

original

copy to file copy to DCJS

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3. This subsequent section is usually fairly simple, STATE OF NEW YORK, CERTIFICATE OF RELIEF FROM, FOR COURT OR BOARD OF PAROLE, This certificate is issued to the, This certificate shall NOT be, See reverse side for explanation, The original certificate is to be, Used by DCJS, Holder of Certificate, Last Name First Name Initial, NYSID, s u p p l y i f u n k n o w n, Crime or Offense for which, Date of arrest, and Date of sentence - all these blanks has to be filled out here.

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