This government document is issued by Office of the Governor for use in California
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https://www.google.com/url?client=internal-element-cse&cx=001779225245372747843:5n03hfyjgga&q=https://www.gov.ca.gov/wp-content/uploads/2023/01/Clemency-Re-Application-FORM.1.23.pdf&sa=U&ved=2ahUKEwid-7GInMSHAxXNW0EAHfGHPG04ChAWegQICRAB&usg=AOvVaw1ju95LMZAtXPGbPl3Vy9_T