INSTRUCTIONS

Fifth Amendment/Use of Controlled Dangerous Substances: Please be aware that you have the right to elect not to answer question number three if you have reasonable cause to believe that answering may expose you to the possibility of criminal prosecution. In that event, you may assert the Fifth Amendment privilege against self-incrimination by answering yes to question number two. Any claim of Fifth Amendment privilege must be made in good faith.

You must fully respond to all other questions in this renewal process. Your application for licensure will be processed if you claim the Fifth Amendment privilege against self-incrimination. You should be aware, however, that you may later be directed by the Attorney General to answer a question which you have refused to answer on the basis of the Fifth Amendment, provided that the Attorney General first grants you immunity afforded by statute, N.J.S.A. 45:1-20.