Pct Biddle J Date of Birth: ( Name: Any former names by which you have been identified ion 2. Report of Arrest or Conv By checking this box, I report that I have been arrested for or convicted of an offense or offenses enumerated under 24 P.S, §§1-1{1le) or (1) Reportable Offensets)"). See Instructions on Page 3 of this Form for 8 list of Reportable Offenses. Ifyou have none to report, proceed to Section 3 of this form, Dee ee For each arrest for or conviction of any Reportable Offense, specify inthe space below (or on auditional attachments ifnecessary) the offense for which you have been arrested or convicted, the date and location of arrest andior conviction, docket number, and the applicable court, ome his box, [state tha have not been arrested for or convicted of any Reportable By signing this form. Ferify under penalty of law thatthe statements made inthis form are true, correct and compl. understand that false statements herein, including, without limitation, any failure to accurately report any arrestor conviction fo 904, relating 'o unsworn falsification 10 Reportable Offense, shall subject me to criminal prosecution under 18 PaCS. ato ) <£ 7/31/17 Dare