Application For Concealed Pistol/revolver License - West Virginia State Police Page 2
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2WVSP 44A
Revised 05/2016
WEST VIRGINIA STATE POLICE
APPLICATION FOR CONCEALED PISTOL/REVOLVER LICENSE
(This application must be completed in ink or by typewriter)
1. The applicant will complete the form (ink or type) and affix his/her signature which must be witnessed by a notary.
2. The completed form will be presented to the Sheriff of the applicant’s resident county accompanied by the required $75.00
application fee.
3. The Sheriff will conduct an investigation relative to the information contained in the application as required by state law.
Any request for criminal history information from the State Police will be made using established protocol.
4. Upon completion of the investigation and if a license to carry a concealed pistol/revolver is approved and issued, the
applicant will pay to the Sheriff an additional $25.00 fee. The Sheriff will immediately forward to the State Police a certified
copy of the approved application and will forward within thirty (30) days the $25.00 fee to the following address:
Superintendent
West Virginia State Police
Attention: Concealed Weapon Registry
701 Jefferson Road
South Charleston, WV 25309-1698
NOTE: Provisional license will expire when Applicant turns 21.
NOTE: Fees waived for the following officials effective July 1, 2013:
Any justice of the Supreme Court of Appeals of West Virginia; any circuit judge; any retired justice or retired circuit judge
designated senior status by the Supreme Court of Appeals of WV; any family court judge; any magistrate; any prosecuting
attorney; any assistant prosecuting attorney; or any duly appointed investigator employed by a prosecuting attorney.
NOTE: No application will be accepted without the NICS Transaction Number listed.
NOTE: When forwarding the $25.00 fee to the West Virginia State Police, the Sheriff must provide the name, date of birth
and date of application approval for each $25.00 fee remitted.
THIS BLOCK TO BE COMPLETED ONLY UPON
Subscribed and sworn before me, in said County
APPROVAL OF APPLICATION BY SHERIFF
and
State,
this
the
_________
day
of
III Check
□YES
□NO
______________________________,
WV CRIMINAL RECORD CHECK □YES □NO
20_________.
My commission expires:______________________
STATE ID No. ______________________________
NICS Check: □ YES □ NO
NICS TRANSACTION No.(NTN):___________________
Notary public signature
NOTE: Application will be returned without NTN#
SEAL:
I, _____________________________________,
Sheriff of _______________________ County, WV
certify this document to be a true and accurate copy
of the APPROVED APPLICATION for a Concealed
Pistol/Revolver Permit for the person identified
herein and have issued a permit as required by law.
Date application received: ______/______/______
________________________________________
Signature
______/______/______ ______/______/______
Received by: _______________________________
Approval Date
Expiration Date
SHERIFF DEPARTMENT USE ONLY
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