HomeMy WebLinkAboutBackground Check - FormVRL/Admin 101 01/22
COUNTY OF HAWAIʻI
DEPARTMENT OF FINANCE
Vehicle Registration & Licensing Division
101 Pauahi Street, Suite 5
Hilo, Hawaii 96720-4224
(808) 961-8413 * (808) 961-8495 (Fax)
CRIMINAL HISTORY BACKGROUND CHECK DECLARATION
“I, ______________________________________________________________,
declare under penalty of law that the attached document accurately reflects my adult
criminal conviction history in Hawaii. I further declare that I have been provided with a
copy of the requirements for owning an electric gun and do not have any convictions or
charges pending against me that disqualify me from owning an electric gun. I further
declare under penalty of law that I am not disqualified from owning an electric gun.”
Signed: _______________________________________________________________
Applicant or Purchaser
Date: ____________________________ Time: ___________________________
Signed: ______________________________________________________________
Seller or Distributor (Witness)
Date: ____________________________ Time: ___________________________
(Seller or Distributor: Please retain this form for your records; do not submit to
the County of Hawaiʻi)