APPLICANT TRANSMITTAL FORM - BILLED

STATE OF CALIFORNIA
JUS 204
(Orig. 01/2004); Rev. 03/2016)
DEPARTMENT OF JUSTICE
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APPLICANT TRANSMITTAL FORM - BILLED
Number of
Applicants
Employment/Licensing/Certifications-General
State Level
Federal Level
Federal Level Volunteer
Social Services
Fee
Total Due
$32
$17
$15
$
DOJ USE ONLY
Trans
Fund
Count
$42
$52
$17
$15
$32
$17
$15
$32
$10
$20
$17
$15
100
110
182
100
600
166
110
182
0017
0017
0017
0017
0017
0017
0017
0017
Trustline
$15
$15
191
0566
Licensing (Lic 198/a)
$15
$15
147
0142
$68
$17
$32
$19
$32
$17
$22
$44
$66
$88
$8
$22
$44
$66
$88
110
100
154
100
110
174
601
602
603
104
175
604
605
606
0017
0017
0460
0017
0017
0460
0460
0460
0460
0017
0460
0460
0460
0460
$32
$50
028
060
100
100
178
3240
3240
0017
0017
0017
100
100
110
153
0017
0017
0017
0460
State Level
Federal Level
Federal Level Volunteer
Child Abuse Index
Retired Peace Officer CCW
Peace Officer
$51
CCW Initial Permit
$71
$93
$115
$137
90-Day Employment
Standard 2 Years
Judge 3 Years
Reserve P.O. 4 Years/Custodial Officer CCW
CCW Renewal Permit
90-Day Employment
Standard 2 Years
Judge 3 Years
Reserve P.O. 4 Years/Custodial Officer CCW
Secondhand Dealer License
Initial License
Renewal License
Fingerprint Cards
Check Casher Permit
$30
$52
$74
$96
$300
$300
$32
$82
Bureau of Security/Investigative Services
License - State Level
Licensing with Firearm:
$32
* Initial Application
$87
$32
$32
$17
$38
* Renewal Application
$38
$38
153
0460
Fingerprint Roller Certification
$32
100
0017
Certification Fee
Record Review
Fingerprint Rolling
Sub-Arrest Notification Transfer
$17
$25
$25
$25
$10
$10
110
619
619
611
142
623
0017
0017
0017
0017
0017
0017
$74
$25
$25
$10
$10
ATTACH A LIST OF NAMES FOR BACKUP.
Do not include a count for fee exempt prints on this form. It is hereby
understood that the attached material will be processed by the Department
of Justice (DOJ) at applicable rates established by state and federal
agencies (subject to change) and that said charges will be paid upon receipt
of DOJ billings.
MAIL TO: CALIFORNIA DEPARTMENT OF JUSTICE
PRESCAN UNIT, K-111
PO BOX 903417, SACRAMENTO, CA 94203-4170
TOTAL BILLED $
Max. 10 Char/Number (optional)
Address
City
Authorized Signature
Date
Number of Reprints
Do not include a count for Reprints.
Client ID
Number
Agency Name
I certify that the above information is correct.
Total $
Phone
Agency
Billing Code
(mandatory)