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Write down the required particulars in As provided in Section Code of, State of, County, City of, to wit Subscribed and sworn to, Signature of Individual Making, My commission expires, My registration is, MMDDYYYY, Signature of Notary Public, NAME AND MAILING ADDRESS OF AGENCY, Mail Reply To, NAME, ATTENTION, and ADDRESS part.
Write down all data you are required in the box Signature of Cardholder, Virginia State Police Charge, Virginia State Police Central, ATTN NEW FORM, FOR STATE POLICE USE ONLY DO NOT, Response based on comparison of, No Conviction Data Does Not, No Criminal Record Name Search, No Criminal Record Fingerprint, No Sex Offender Registration Record, Criminal Record Attached, Purpose code, C N O, Date, and By CCRE.
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