Form Preview Example

SP 8-205 (8-2008)

	COMMONWEALTH OF PENNSYLVANIA
	APPLICATION FOR RENEWAL OF AGENT CERTIFICATION
	LETHAL WEAPONS TRAINING ACT
8002 Bretz Drive	717-346-4087
Harrisburg, PA 17112-9748	www.lethalweapons.state.pa.us

INSTRUCTIONS:

If you are within six months of your current expiration, submit this completed application with a certified check, cashier's check, or money order in the amount of $30.00 made payable to the "Commonwealth of PA" to the address listed above.

NO PERSONAL OR COMPANY CHECKS WILL BE ACCEPTED.

Police Officers who are NOT currently certified under MPOETC must also submit the LWTA Verification Procedure for Renewal Training Waiver form (SP 8-204B). NOTE: Retired State Police and 120 Officers are not waived of Renewal Training.

NOTE: This application, if approved, establishes eligibility to enroll in a renewal lethal weapons training course conducted at a school or training facility certified by the Pennsylvania State Police.

TO BE COMPLETED BY APPLICANT

SOCIAL SECURITY NUMBER

PA DRIVER’S LICENSE NUMBER OR PA PHOTO ID NO.

ARE YOU A POLICE OFFICER WHO IS CERTIFIED UNDER MPOETC?

YESNO

1. LAST NAME

FIRST

MIDDLE

2. DATE OF BIRTH (MO.-DAY-YR.) 3. TELEPHONE NO. (INCLUDE AREA CODE)

4. ADDRESS

CITY/BORO

COUNTY

STATE ZIP CODE

5. CERTIFICATION NO. (INCL. CLASS)		6. PRESENT EMPLOYER & TELEPHONE NO.

7. ADDRESS

8.
HAVE YOU EVER BEEN ARRESTED OR CHARGED WITH VIOLATION OF THE LAW? (INCLUDING TRAFFIC VIOLATION)						YES	NO
(IF YES, EXPLAIN BELOW AND INDICATE ALL ARRESTS AND DISPOSITIONS, EXCLUDING PARKING TICKETS)

DATE	LOCATION		CHARGE		DISPOSITION

A.

B.

C.

D.

9.
HAVE YOU EVER BEEN CONVICTED OF A CRIME ENUMERATED IN SECTION 6105(b)?				(READ INFORMATION ON		YES	NO
BACK PRIOR TO ANSWERING.)
10.
ARE YOU NOW CHARGED WITH, OR HAVE YOU EVER BEEN CONVICTED OF A CRIME PUNISHABLE BY						YES	NO
IMPRISONMENT FOR A TERM EXCEEDING ONE YEAR? (THIS DOES NOT INCLUDE FEDERAL OR STATE OFFENSES
PERTAINING TO ANTITRUST, UNFAIR TRADE PRACTICES, RESTRAINTS OF TRADE, OR REGULATION OF BUSINESS;
OR STATE OFFENSES CLASSIFIED AS MISDEMEANORS AND PUNISHABLE BY A TERM OF IMPRISONMENT NOT TO
EXCEED TWO YEARS.)
11.
HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE UNDER THE ACT OF APRIL 14, 1972 (P.L. 233, NO. 64), KNOWN						YES	NO
AS THE CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT?
12.
ARE YOU AN INDIVIDUAL WHO, WITHIN THE PAST TEN YEARS, HAS BEEN ADJUDICATED A DELINQUENT FOR A						YES	NO
CRIME ENUMERATED IN SECTION 6105(b)? (REFER TO INFORMATION ON BACK.)
13.
ARE YOU AN INDIVIDUAL WHO IS NOT OF SOUND MIND OR WHO HAS EVER BEEN COMMITTED TO A MENTAL						YES	NO
INSTITUTION?
14.
ARE YOU A UNITED STATES CITIZEN?						YES	NO
IF NO, ENTER IMMIGRATION IDENTIFICATION NUMBER: ______________________________________
15.
ARE YOU AN INDIVIDUAL WHO HAS BEEN DISCHARGED FROM THE ARMED FORCES OF THE UNITED STATES						YES	NO
UNDER DISHONORABLE CONDITIONS?
16.
IS YOUR CHARACTER AND REPUTATION SUCH THAT YOU WOULD BE LIKELY TO ACT IN A MANNER DANGEROUS						YES	NO
TO PUBLIC SAFETY?
17.
ARE YOU A HABITUAL DRUNKARD?						YES	NO

18.
HAVE YOU EVER BEEN CONVICTED OF A CRIME OF VIOLENCE IN THE COMMONWEALTH OF PENNSYLVANIA OR						YES	NO
ELSEWHERE?

ARE YOU A PERSON WHO?

19.
IS A FUGITIVE FROM JUSTICE?			YES	NO

20.
HAS BEEN CONVICTED OF AN OFFENSE UNDER THE ACT OF APRIL 14, 1972 (P.L. 233, NO. 64), KNOWN AS THE			YES	NO
CONTROLLED SUBSTANCE DRUG, DEVICE AND COSMETIC ACT, THAT MAY BE PUNISHABLE BY A TERM OF
IMPRISONMENT EXCEEDING TWO YEARS?
21.
HAS BEEN CONVICTED OF DRIVING UNDER THE INFLUENCE OF ALCOHOL OR CONTROLLED SUBSTANCE AS			YES	NO
PROVIDED IN TITLE 75, VEHICLE CODE, SECTIONS 3731 AND/OR 3802 (RELATING TO DRIVING UNDER THE
INFLUENCE OF ALCOHOL OR CONTROLLED SUBSTANCE) ON THREE OR MORE SEPARATE OCCASIONS WITHIN A
FIVE-YEAR PERIOD?
22.
HAS BEEN ADJUDICATED AS AN INCOMPETENT OR WHO HAS BEEN INVOLUNTARILY COMMITTED TO A MENTAL			YES	NO
INSTITUTION FOR INPATIENT CARE AND TREATMENT UNDER SECTION 302, 303, OR 304 OF THE PROVISIONS OF THE
ACT OF JULY 9, 1976 (P.L. 817, NO. 143), KNOWN AS THE MENTAL HEALTH PROCEDURES ACT?
23.
BEING AN ALIEN, IS ILLEGALLY OR UNLAWFULLY IN THE UNITED STATES?			YES	NO

24.
IS THE SUBJECT OF AN ACTIVE PROTECTION FROM ABUSE ORDER ISSUED PURSUANT TO 23 Pa.C.S. SECTION 6108			YES	NO
(RELATING TO RELIEF), WHICH ORDER PROVIDES FOR THE CONFISCATION OF FIREARMS DURING THE PERIOD OF
TIME THE ORDER IS IN EFFECT. THIS PROHIBITION SHALL TERMINATE UPON THE EXPIRATION OR VACATION OF AN
ACTIVE PROTECTION FROM ABUSE ORDER OR PORTION THEREOF RELATING TO THE CONFISCATION OF
FIREARMS?
25.
WAS ADJUDICATED DELINQUENT BY A COURT PURSUANT	TO 42 Pa.C.S. SECTION 6341 (RELATING TO		YES	NO
ADJUDICATION) OR UNDER ANY EQUIVALENT FEDERAL STATUTE OR STATUTE OF ANY OTHER STATE AS A RESULT
OF CONDUCT WHICH IS COMMITTED BY AN ADULT WOULD CONSTITUTE AN OFFENSE UNDER SECTIONS 2502, 2503,
2702, 2703, 2704, 2901, 3121, 3123, 3301, 3502, 3701, AND 3923 (LISTED BELOW)?
26.
WAS ADJUDICATED DELINQUENT BY A COURT PURSUANT TO 42 Pa.C.S. SECTION 6341 OR UNDER ANY EQUIVALENT			YES	NO
FEDERAL STATUTE OR STATUTE OF ANY OTHER STATE AS A RESULT OF CONDUCT WHICH IF COMMITTED BY AN
ADULT WOULD CONSTITUTE AN OFFENSE ENUMERATED IN SECTION 6105(b)? (SEE BELOW.) THE PROHIBITION
SHALL TERMINATE 15 YEARS AFTER THE LAST APPLICATION DELINQUENT ADJUDICATION OR UPON THE PERSON
REACHING THE AGE OF 30, WHICHEVER IS EARLIER.

§ 6105(b):
§ 908 PROHIBITED OFFENSIVE WEAPONS.	* § 3701	ROBBERY.
§ 911 CORRUPT ORGANIZATIONS.	§ 3702	ROBBERY OF MOTOR VEHICLE.
§ 912 POSSESSION OF WEAPON ON SCHOOL PROPERTY.	§ 3921	THEFT BY UNLAWFUL TAKING OR DISPOSITION, UPON
* § 2502 MURDER.		CONVICTION OF THE SECOND FELONY OFFENSE.
* § 2503 VOLUNTARY MANSLAUGHTER.	* § 3923	THEFT BY EXTORTION, WHEN THE OFFENSE IS
§ 2504 INVOLUNTARY MANSLAUGHTER, IF THE OFFENSE IS BASED		ACCOMPANIED BY THREATS OF VIOLENCE.
ON THE RECKLESS USE OF A FIREARM.	§ 3925	RECEIVING STOLEN PROPERTY, UPON CONVICTION OF
* § 2702 AGGRAVATED ASSAULT.		THE SECOND FELONY OFFENSE.
* § 2703 ASSAULT BY PRISONER.	§ 4912	IMPERSONATING A PUBLIC SERVANT, IF THE PERSON IS
* § 2704 ASSAULT BY LIFE PRISONER.		IMPERSONATING A LAW ENFORCEMENT OFFICER.
§ 2709 HARASSMENT AND STALKING, IF THE OFFENSE RELATES	§ 4952	INTIMIDATION OF WITNESSES OR VICTIMS.
TO STALKING.	§ 4953	RETALIATION AGAINST WITNESS OR VICTIM.
* § 2901 KIDNAPPING.	§ 5121	ESCAPE.
§ 2902 UNLAWFUL RESTRAINT.	§ 5122	WEAPONS OR IMPLEMENTS FOR ESCAPE.
§ 2910 LURING A CHILD INTO A MOTOR VEHICLE.	§ 5501	RIOT, IF THE OFFENSE RELATES TO A FIREARM OR
* § 3121 RAPE.		OTHER DEADLY WEAPON.
* § 3123 INVOLUNTARY DEVIATE SEXUAL INTERCOURSE.	§ 5515	PROHIBITING OF PARAMILITARY TRAINING.
§ 3125 AGGRAVATED INDECENT ASSAULT.	§ 6110.1 POSSESSION OF FIREARM BY MINOR.
* § 3301 ARSON AND RELATED OFFENSES.	§ 6301	CORRUPTION OF MINORS.
§ 3302 CAUSING OR RISKING CATASTROPHE.	§ 6302	SALE OR LEASE OF WEAPONS AND EXPLOSIVES.
* § 3502 BURGLARY.
§ 3503 CRIMINAL TRESPASS, IF THE OFFENSE IS GRADED A	ANY OFFENSE EQUIVALENT TO ANY OF THE ABOVE-ENUMERATED
FELONY OF THE SECOND DEGREE OR HIGHER.	OFFENSES UNDER THE PRIOR LAWS OF THIS COMMONWEALTH, OR
	ANY OFFENSE EQUIVALENT TO ANY OF THE ABOVE-ENUMERATED
	OFFENSES UNDER THE STATUTES OF ANY OTHER STATE OR OF
	THE UNITED STATES.

CERTIFICATION

I HEREBY CERTIFY THAT THIS FORM CONTAINS NO MISREPRESENTATION OR FALSIFICATIONS, OMISSIONS, OR CONCEALMENT OF MATERIAL FACT AND THAT THE INFORMATION GIVEN IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT I AM SIGNING THIS DOCUMENT WITH THE FULL UNDERSTANDING THAT ANY FALSE INFORMATION OR STATEMENT WILL SUBJECT ME TO THE CRIMINAL PENALTIES OF TITLE 18, CRIMES CODE, SECTION 4904, RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES, AND COULD RESULT IN PERMANENT DISQUALIFICATION OF A LETHAL WEAPONS AGENT.

_________________________________________________________________

SIGNATURE - APPLICANT

DATE

If you have any questions or concerns, you can contact the Lethal Weapons Unit at 717-346-4087 or via email.

Question	Answer
Form Name	Sp 8 205 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	OMISSIONS, sp 8 205 application for renewal of agent certification, Bretz, 8-204B

Sp 8 205 Form – Fill Out and Use This PDF

Sp 8 205 Form PDF Details

Form Preview Example

Sp 8 205 Form isn’t the one you’re looking for?

Sp 8 205 Form – Fill Out and Use This PDF

Sp 8 205 Form PDF Details

Form Preview Example

Sp 8 205 Form isn’t the one you’re looking for?

Related Documents