Date __________________________________________ Name __________________________________________ Address __________________________________________ __________________________________________ Date of Birth __________________________________________ CA ID# __________________________________________ (Police department name) has performed a criminal history check and reviewed the (identification type, example: drivers license) on (applicant name). This letter is to certify that (applicant name) has no conviction for any violation of law or outstanding warrant with this police department. It also certifies that the name, birth date and address set forth above are accurate based upon the review of applicant's identification. The applicant attests that (he/she) has been a resident of (locality) for the past (number) year(s). A search of our records reflects that there is no criminal record on file, and there is no arrest warrant or criminal process currently outstanding or pending in this jurisdiction against the applicant. ______________________________________ (Signature) ______________________________________ (Print name and title) (affix official seal below, seal must be affixed or this will not be acceptable)