Legal Penal Codes Statement

LEGAL PENAL CODES STATEMENT

This Legal Penal Codes Statement is made as of by and between Declarant Name: , Declarant Address: , and Recipient Name: , Recipient Address: .

RECITALS

WHEREAS, Declarant is required by Recipient to provide a truthful written statement disclosing all arrests, charges, convictions, diversions, adjudications, deferred entries of judgment, and other final or non-final dispositions relevant to penal code violations that may bear on Declarant's fitness, eligibility, or legal status in connection with obligations to Recipient; and

WHEREAS, Recipient requires such disclosure to evaluate compliance with applicable legal standards, contractual commitments, licensing requirements, and public safety obligations; and

WHEREAS, Declarant acknowledges that false statements, omissions, or failure to disclose material penal code matters may expose Declarant to civil and criminal penalties, including but not limited to penalties for perjury and rescission of agreements.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

For purposes of this Statement, the following terms shall have the meanings set forth below:

"Arrest" means any custody, detention, or apprehension by law enforcement that led to booking, citation, or formal charges. "Conviction" means a plea of guilty or nolo contendere, a verdict of guilty, or any judgment of conviction whether final or suspended. "Penal Code Section" means the numerical citation identifying the statutory offense under applicable criminal law.

2. STATEMENT OF PENAL CODE MATTERS

Declarant represents and warrants that Declarant has fully and truthfully disclosed below all arrests, charges, convictions, diversions, juvenile adjudications, deferred adjudications, sealed or expunged matters that are not legally prohibited from disclosure, and any pending criminal matters, whether adjudicated by a court, plea agreement, or administrative finding, that relate to penal code violations.

Does Declarant have any prior arrests, charges, convictions, diversions, adjudications, or pending matters to disclose? Yes No

3. DISCLOSURE DETAILS

If yes, provide the following details for each matter. Repeat entries as necessary; additional pages may be attached and incorporated by reference.

4. REPRESENTATIONS AND WARRANTIES

Declarant represents and warrants that all factual statements made in this Statement are complete and accurate to the best of Declarant's knowledge. Declarant further warrants that Declarant has not intentionally omitted any material penal code matter that would be required to be disclosed under the Recipient's policies or applicable law.

Declarant acknowledges that Recipient may rely on the representations contained herein, and that material misrepresentation or omission shall constitute a breach entitling Recipient to remedies at law or equity, including rescission of agreements, employment termination, or other sanctions.

5. CERTIFICATION UNDER PENALTY

Declarant certifies under penalty of perjury under the laws of the state identified in Section 11 that the statements and disclosures set forth in this document are true and correct. Declarant acknowledges that knowingly providing false information or wilful omission of material facts may subject Declarant to criminal prosecution, including prosecution for perjury, and civil liability.

I certify that the foregoing is true and correct: I certify under penalty of perjury

6. CONSENT TO VERIFICATION

Declarant consents to reasonable verification of the information provided herein, including background checks, criminal history records inquiries, and verification with courts or law enforcement agencies. Such consent is limited to the purposes set forth by Recipient and is subject to applicable law governing access to and use of criminal records.

Consent to verification Do not consent

7. NOTICES

Any notice required or permitted under this Statement shall be in writing and shall be delivered to the addresses set forth in the opening paragraph or to such other address as either party designates in writing.

8. MISCELLANEOUS

Governing Law: This Statement shall be governed by and construed in accordance with the laws of the state of , without regard to its conflict of law principles.

Entire Agreement: This Statement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to the disclosure of penal code matters.

Severability: If any provision of this Statement is found to be invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect and the invalid or unenforceable provision shall be reformed only to the minimum extent necessary to make it enforceable.

Amendments; Waiver: No amendment or waiver of any provision of this Statement shall be effective unless in writing and signed by both parties. The waiver of any breach shall not constitute a waiver of any subsequent breach.

Counterparts: This Statement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures provided by electronic image or facsimile shall be effective for all purposes.

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