This government document is issued by Sheriffs for use in Santa Cruz County, CA
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https://www.google.com/url?client=internal-element-cse&cx=014495650983952418263:sdgp9gybu4g&q=http://www.co.santa-cruz.ca.us/Portals/0/Personnel%2520Files/PandP/Forms/PER1081B.pdf&sa=U&ved=2ahUKEwj2p67Gkdr6AhWIQfEDHe_eAwI4HhAWegQICBAB&usg=AOvVaw3gEUMvwMf9WH5x6COQ-afy