Concealed Handgun Carry License Application Form

QUESTIONS RELATED TO OTHER CRIMINAL HISTORY

14. Have you been convicted of a crime(s) that involves physical contact or threat of

physical contact with a family member, intimate partner, your child or a child of the

intimate partner? _________________. If yes, explain further on a separate piece of paper

15. Have you been convicted of a crime of violence? ________________________ If yes,

explain further on a separate piece of paper.

16. Have you been convicted of any crime involving the use of a weapon? ______________

17. Have you ever been convicted of a felony? _________________

NOTE – if you were

sentenced after March 13, 1995, you must have a governor’s pardon with firearms

possession rights restored. A seal/expungement order will not necessarily restore your

firearms rights.

18. Within the last five (5) years have you ever been convicted of the offense of carrying

a weapon? ________________ If yes, give the court and date of conviction. ______________

_______________________________________________________________________________________

19. Are you the subject of an active criminal warrant?

Yes

Unknown

(Circle one)

QUESTIONS RELATING TO FEDERAL LAW

20. Have you ever been denied a concealed handgun carry license in any state?

___________________ If yes, what state? ________________________

21. Have you ever been denied for the purchase of a firearm through a federal firearms

licensee (gun dealer)? ______________ If yes, explain further on a separate piece of paper.

22. Have you ever been convicted in any court of a crime punishable by imprisonment

for a term exceeding one (1) year? _______________.

23. Have you recently been arrested for or are you under indictment or information for

a crime punishable by imprisonment for a term exceeding one year? _________________ If

yes, explain further on a separate piece of paper.

24. Have you have ever served in the Armed Forces and been discharged under

dishonorable conditions? ___________________ (dishonorable discharge or dismissal)

25. Have you ever been convicted of an offense at an Armed Forces General Court

Martial? __________________ If so, what was the offense? ______________________________

26. Are you a fugitive from justice? ______________________

27. Are you subject to any law that makes it unlawful to receive, possess or transport

any firearm? _________________

28. Have you ever submitted information to the FBI for the Voluntary Appeal File (VAF)?

If yes, was a VAF number issued to you? ________ If yes, list that number: _____________

29. Are you an illegal or unlawful alien?________________________

Revised November 2015

Concealed Handgun Carry License Application Form - 2015 Page 3