Application For Firearm Owner'S Identification Card Form - Illinois State Police Page 2

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ONLY FOR “UNDER 21 YEARS OF AGE” APPLICATIONS

PARENT/LEGAL GUARDIAN AFFIDAVIT

Parent or Legal Guardian Signature Certi ﬁ cati on: I being ﬁ rst duly sworn upon oath, states as follows: (1) I am not currently prohibited from holding

a FOID card insofar as: (a) I have not been convicted of a felony or have been granted relief from such convicti on to hold a FOID card; (b) I have not,

in the past 5 years, been a pati ent in a mental insti tuti on or any medical facility used primarily for the care or treatment of persons for mental illness;

(c) I am not addicted to narcoti cs; (d) I am not intellectually disabled; (e) I am not subject to an existi ng order of protecti on which prohibits me from

possessing a ﬁ rearm; (f) I have not, within the past 5 years, been convicted of batt ery, assault, aggravated assault, violati on of an order of protecti on,

or a substanti ally similar oﬀ ense in which a ﬁ rearm was used or possessed; (g) I have not ever been convicted of a domesti c batt ery or a substanti ally

similar oﬀ ense (misdemeanor or felony); (h) I have not been adjudicated a delinquent minor for the commission of an oﬀ ense that if committ ed by

an adult would be a felony; (i) I am not an alien who is unlawfully present in the United States; and (j) I have never been adjudicated as a mental

defecti ve. (2) I hereby give my consent for this minor applicant to possess and acquire ﬁ rearms and ﬁ rearm ammuniti on and understand I shall be

liable for any damages resulti ng from the minor applicant’s use of ﬁ rearms or ﬁ rearm ammuniti on. FURTHER AFFIANT SAYETH NOT.

I hereby authorize the Illinois State Police to verify answers given with any government or private enti ty authorized to hold records relevant to my

citi zenship, criminal history and mental health treatment or history.

_______________________________________________

Parent or Legal Guardian Signature

Subscribed and sworn to before me this _____________________________________ day of _________________________ , _______________ .

_______________________________________________

Notary Public

Note: Any person who is prohibited from acquiring or possessing ﬁ rearms or ﬁ rearm ammunition by any Illinois state statute or