Ag Form 1r - State Of Maine Application For Permit To Carry Concealed Firearms (Page 4 of 6) in pdf

Ag Form 1r - State Of Maine Application For Permit To Carry Concealed Firearms Page 4

z. Have you been convicted in any jurisdiction within the past 5 years of 3 or

more crimes punishable by a term of imprisonment of less than one year or of

crimes classified under the laws of a state as a misdemeanor and punishable

by a term of imprisonment of 2 years or less? ----------------------------------------- YES

aa. Have you been adjudicated in any jurisdiction within the past 5 years to

YES

have committed 3 or more juvenile offenses described in question (o)? --------

bb. To your knowledge, have you engaged within the past 5 years in reckless

or negligent conduct [as defined at 25 M.R.S.A. § 2002(11)] that has been the

YES

subject of an investigation by a governmental entity?--------------------------------

cc. Have you been convicted in a Maine court within the past 5 years of any

Title 17-A, chapter 45 drug crime?------------------------------------------------------- YES

dd. Have you been adjudicated in a Maine court within the past 5 years as

having committed a juvenile offense involving conduct that, if committed by

an adult, would have been a violation of Title 17-A, chapter 45? [Drugs

YES

offenses] --------------------------------------------------------------------------------------

ee. Have you been adjudged in a Maine court to have committed the civil

violation of possession of a useable amount of marijuana, butyl nitrite or

isobutyl nitrite in violation of Title 22 M.R.S.A. § 2383 within the past 5

YES

years?-------------------------------------------------------------------------------------------

ff. Have you been adjudicated in a Maine court within the past 5 years as

having committed the juvenile crime defined in Title 15 M.R.S.A. § 3103 (1)

(B) of possession of a useable amount of marijuana, as provided in Title 22

YES

M.R.S.A. § 2383?-----------------------------------------------------------------------------

[continued on next page]

PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE AND SHOULD NOT BE USED

Initials______

AG Form 1R (8/06)

Page 4 of 6

Ag Form 1r - State Of Maine Application For Permit To Carry Concealed Firearms Page 4