(A) You have been adjudicated delinquent of any of the ITALICIZED OFFENSES listed below EVER, OR
(B) you have been adjudicated delinquent of any of the other remaining offenses listed below WITHIN THE LAST 15 YEARS(does NOT apply if you are 30 years of age or older), OR
(C) you have been convicted of any of the offenses below, EVER?
Section 908 (relating to prohibited offensive weapons).
Section 911 (relating to corrupt organizations).
Section 912 (relating to possession of weapon on school property).
Section 2502 (relating to murder).
Section 2503 (relating to voluntary manslaughter).
Section 2504 (relating to involuntary manslaughter) if the offense is based on the reckless use of a firearm.
Section 2702 (relating to aggravated assault).
Section 2703 (relating to assault by prisoner).
Section 2704 (relating to assault by life prisoner).
Section 2709.1 (relating to stalking).
Section 2716 (relating to weapons of mass destruction).
Section 2901 (relating to kidnapping).
Section 2902 (relating to unlawful restraint).
Section 2910 (relating to luring a child into a motor vehicle or structure).
Section 3121 (relating to rape).
Section 3123 (relating to involuntary deviate sexual intercourse).
Section 3125 (relating to aggravated indecent assault).
Section 3301 (relating to arson and related offenses).
Section 3302 (relating to causing or risking catastrophe).
Section 3502 (relating to burglary).
Section 3503 (relating to criminal trespass) if the offense is graded a felony of the second degree or higher.
Section 3701 (relating to robbery).
Section 3702 (relating to robbery of motor vehicle).
Section 3921 (relating to theft by unlawful taking or disposition) upon conviction of the second felony offense.
Section 3923 (relating to theft by extortion) when the offense is accompanied by threats of violence.
Section 3925 (relating to receiving stolen property) upon conviction of the second felony offense.
Section 4906 (relating to false reports to law enforcement authorities) if the fictitious report involved the theft of a firearm as provided.
Section 4912 (relating to impersonating a public servant) if the person is impersonating a law enforcement officer.
Section 4952 (relating to intimidation of witnesses or victims).
Section 4953 (relating to retaliation against witness, victim or party).
Section 5121 (relating to escape).
Section 5122 (relating to weapons or implements for escape).
Section 5501(3) (relating to riot).
Section 5515 (relating to prohibiting of paramilitary training).
Section 5516 (relating to facsimile weapons of mass destruction).
Section 6110.1 (relating to possession of firearm by minor).
Section 6301 (relating to corruption of minors).
Section 6302 (relating to sale or lease of weapons and explosives).
Any offense equivalent to any of the above-enumerated offenses under the prior laws of this Commonwealth or any offense equivalent
to any of the above-enumerated offenses under the statutes of any other state or of the United States.
1. (A) Are you under indictment for, (B) have you been formally charged with, or (C) have you ever been convicted of:
any State criminal offense the maximum possible term of imprisonment for which is more than two years(which in
Pennsylvania refers to any Misdemeanor in the First Degree or any Felony) or any Federal criminal offense the maximum
possible term of imprisonment for which is more than one year?
2. Have you ever been convicted of Driving Under the Influence of alcohol or a controlled substance on three or more separate
occasions within a five year period?
3. Have you ever been convicted of any misdemeanor crime of domestic violence as defined by 921(a)(33)(A) of the GCA?
4. Are you a fugitive from justice?
5. Are you the subject of an active court order restraining you from harassing, stalking or threatening ("Protection From Abuse")?
6. Are you an unlawful user of or addicted to any depressant, stimulant or controlled substance?
7. Have you ever been discharged from the Armed Forces under dishonorable conditions?
8. Have you ever been adjudicated as an incompetent or a mental defective, or committed to a mental institution?
9. Being an alien, are you illegally or unlawfully in the United States (U.S.), OR have you been admitted to the U.S. under a
nonimmigrant visa (unless you were admitted to the U.S. for lawful hunting or sporting purposes, or are in possession of a
hunting license or permit lawfully issued in the U.S.)?
10. Having you ever renounced your U.S. citizenship?