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Race Sex Driver's Lice nse State I Num ber Current Address City State Zi!;! Code Previous Address City State ZiQ Code I Number I Within the last seven years, have you been convicted of a misdemeanor, other than a minor traffic infraction, or a 0 Yes 0 No felony? If YES, please explain: Please list any prior criminal or civil onvictions or traffic violations, no matter what the final dispositio n (i.e. felony, misdemeanor, etc.). Prior convictions do not automatically disqualify an.

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