Sp-248 - Application For Concealed Handgun Permit Commonwealth Of Virginia Page 2
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41
FORM
PART A PENDING CHARGES
(
,
)
FOR ADDITIONAL PENDING CHARGES
USE A PIECE OF PLAIN PAPER AND ATTACH
:
________________________________________________________
DESCRIBE THE PENDING CRIMINAL CHARGE AGAINST YOU
: ___________________
,
: _____________________________________
DATE OF CHARGE
COUNTY
CITY AND STATE OF CHARGE
:
___________________________________________________________________________
CURRENT STATUS OF CHARGE
PART B CONVICTIONS
(
,
)
FOR ADDITIONAL CONVICTIONS
USE A PIECE OF PLAIN PAPER AND ATTACH
:
_______________________________________________________
DESCRIBE THE CHARGE FOR WHICH YOU WERE CONVICTED
:___________________
,
: __________________________________
DATE OF CONVICTION
COUNTY
CITY AND STATE OF CHARGE
?
HAVE YOU RECEIVED A PARDON OR RESTORATION OF RIGHTS THAT INCLUDES YOUR FIREARM RIGHTS
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
2
FORM
PART A COMMITMENTS TO THE COMMISSIONER OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
:_______________
:_________________________________
DATE OF COMMITMENT
DATE YOU WERE RELEASED FROM CUSTODY
: __________________________________________________________________
NAME OF COURT WHICH ENTERED THE ORDER
(
,
,
,
)
LOCATION OF COURT
INCLUDE STREET ADDRESS
CITY
COUNTY
AND STATE
_____________________________________________________________________________________________________
?
HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT
YES
NO
,
?
IF YES
HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
PART B ADJUDICATION OF LEGAL INCOMPETENCE OR MENTAL INCAPACITATION
:________________
:_____________________________
DATE OF ADJUDICATION
NAME OF COURT WHICH ENTERED THE ORDER
(
,
,
,
)
LOCATION OF COURT
INCLUDE STREET ADDRESS
CITY
COUNTY
AND STATE
_____________________________________________________________________________________________________
?
HAS YOUR COMPETENCY OR CAPACITY HAS BEEN RESTORED BY A COURT
YES
NO
,
?
IF YES
HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
PART C
INVOLUNTARY ADMISSIONS
: ________________________
:____________________
DATE INVOLUNTARILY ADMITTED
DATE RELEASED FROM THIS ADMISSION
: __________________________________________________________________
NAME OF COURT WHICH ENTERED THE ORDER
(
,
,
,
)
LOCATION OF COURT
INCLUDE STREET ADDRESS
CITY
COUNTY
AND STATE
____________________________________________________________________________________________________
?
HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT
YES
NO
,
?
IF YES
HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
PART D MANDATORY OUTPATIENT TREATMENT
:
____________________________________________________
DATE ORDERED TO MANDATORY OUTPATIENT TREATMENT
:
____________________________________________________
DATE RELEASED FROM MANDATORY OUTPATIENT TREATMENT
: _________________________________________________________________
NAME OF COURT WHICH ENTERED THE ORDER
(
,
,
,
)
LOCATION OF COURT
INCLUDE STREET ADDRESS
CITY
COUNTY
AND STATE
____________________________________________________________________________________________________
?
HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT
YES
NO
,
?
IF YES
HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
PART E VOLUNTARY ADMISSION SUBSEQUENT TO A TEMPORARY DETENTION ORDER
(
):_________________________________________________________________
DATE OF TEMPORARY DETENTION ORDER
TDO
(
),
AFTER BEING SUBJECT TO A TEMPORARY DETENTION ORDER
TDO
DID YOU SUBSEQUENTLY AGREE TO VOLUNTARY ADMISSION PURSUANT TO VA
§37.2-805?
CODE
YES
NO
,
: ____________________________________________________________
IF YES
NAME OF COURT WHICH ENTERED THE ORDER
(
,
,
,
)
LOCATION OF COURT
INCLUDE STREET ADDRESS
CITY
COUNTY
AND STATE
____________________________________________________________________________________________________
?
HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT
YES
NO
,
?
IF YES
HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION
YES
NO
,
.
IF YES
ATTACH SUPPORTING DOCUMENTATION
2
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