SAN BERNARDINO COUNTY SHERIFF’S DEPARTMENT
655 East Third Street • San Bernardino, California 92415-0061 Post Office Box 569 • San Bernardino, California 92402-0569
SHANNON D. DICUS, SHERIFF-CORONER
DOMESTIC VIOLENCE
DISCLOSURE STATEMENT
On September 30, 1996, Title 18 United States Code § 922 (g)(9) took effect. This section
of the United States Code PROHIBITS FOR LIFE the possession of ANY FIREARM OR
AMMUNITION by any person who has been convicted of a “Misdemeanor crime of domestic
violence.”
As defined by the Federal Law, a “misdemeanor crime of domestic violence” means an
offense that:
1. is a misdemeanor under federal or state law; and
2. has as an element, the use or attempted use of physical force, or the
threatened use of a deadly weapon committed by a current or former spouse,
parent, or guardian of the victim, by a person with whom the victim shares
a child in common, by a person who is cohabiting with or has cohabited
with the victim as a spouse, parent, or guardian of the victim
The Bureau of Alcohol, Tobacco and Firearms has issued an opinion interpreting the new
federal statue to include any offense, whether or not explicitly described in the statue as a crime of
domestic violence, which has, as its factual basis, the use or attempted use of physical force, or
threatened use of a deadly weapon committed by the victim’s current or former domestic partner,
parent, or guardian. The only persons exempt from this law are people who have had a conviction
of this nature expunged, set aside, or dismissed pursuant to Penal Code Section 1203.4.
I have read and understand the above information. I understand that any conviction of any
crime or offense which is outlined in the above information, no matter how old, prohibits me from
possessing any firearm. I swear, under penalty of perjury, that to the best of my knowledge I have
never been convicted of any CRIME OF DOMESTIC VIOLENCE.
I also understand that this document is part of the application process as defined under
Penal Code § 12051 and that knowingly providing false information as it relates to the above noted
information is a Felony.
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Applicant’s Signature Witness/SBSD Agent
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