Form Dp 52 PDF Details

Form Dp 52 is a document used to request waivers from the Department of Defense for Procurement. The form is also used to request exceptions to certain DoD regulations. In order to complete Form Dp 52, you will need to provide justification for the waiver or exception. This document can be used by businesses in order to procure goods and services from the DoD. Completed forms should be submitted to the appropriate contracting officer.

QuestionAnswer
Form NameForm Dp 52
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescjtn lookup, nysid lookup, how do i find my nysid number, nys id number lookup

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STATE OF NEW YORK

APPLICATION BY AN ELIGIBLE OFFENDER FOR

A CERTIFICATE OF RELIEF FROM DISABILITIES

I Applicant' s Last Name

First Name

Middle Initial

FOR COURT OR BOARD OF PAROLE Docket, File or other Identifying No.

3.NYSID Number (if Known)

2. Address (Street and No., City, State, Zip Code)

4. Sex

5.

Color

 

 

6. Height

 

 

T Date of Birth (Month, Day, Year)

Male

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ft.

In.

8. Crime or offense of which convicted

 

 

 

 

 

9. Date of Arrest

 

 

I 0. Date of Sentence

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 1. Court of Sentence (Court, Part, Term, Venue)

 

 

 

 

 

12. Certificate requested from

a

b

COURT INDICATED IN NUMBER I 1

STATE BOARD OF PAROLE

13.If certificate being applied for

Is intended to replace an existing certificate, enter issue date of original certificate.

Date:

Not Applicable

14. Application is hereby made for a grant of a ''CERTIFICATE OF RELIEF FROM DISABILITIES'' which will:

a

Relieve the holder of all forfeitures, and of all disabilities and bars to employment, excluding the right to retain or to be eligible for public

 

office, by virtue of the fact that the certificate is issued at the time of sentence.

b

Relieve the holder of all disabilities and bars to employment, excluding the right to be eligible for public office.

c

Relieve the holder of the forfeitures, disabilities or bars to employment hereinafter enumerated

 

 

 

 

15.The applicant agrees to allow an investigation to be made to determine his fitness for a certificate of relief from disabilities, pursuant to Art. 23, Correction Law,

Applicant's Signature

 

Date

STATE OF NOW York

County of

being duly sworn, deposes and says that he is the applicant named in the within application; that

he has read the foregoing application and knows the contents thereof, that the same is true to his own knowledge, except as to the matters therein stated to be alleged on information and belief, and that as to those matters he believes it to be true.

Sworn to before me this

 

day of

200

Notary Public

Form DP-52 (Rev. 9/72)

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