Self-Defense Act Applicant Local Agency Report Form - Oklahoma
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1OKLAHOMA SELF-DEFENSE ACT APPLICANT LOCAL AGENCY REPORT
This form is to be completed by the sheriff’s office in the applicant’s county of residence.
Applicant Name: _______________________________ Alias(es): ________________________________________
Date of Birth: __________________________________ Social Security Number: ____________________________
County of Residence: ___________________________ City of Residence: _________________________________
Date Received: _________________________________ Date Completed: __________________________________
COUNTY INFORMATION
Records from the Sheriff’s Office were checked by _________________________________ Title ____________________
Charges / Arrests / Incidents:
Date:
Disposition:
NO RECORD
NO AGENCY RESPONSE
Date Checked __________
Records from the Court Clerk’s Office were checked by _____________________________ Title ____________________
Charges / Arrests / Incidents:
Date:
Disposition:
NO RECORD
NO AGENCY RESPONSE
Date Checked __________
Records from the District Attorney’s Office were checked by _________________________ Title ____________________
Charges / Arrests / Incidents:
Date:
Disposition:
NO RECORD
NO AGENCY RESPONSE
Date Checked __________
MUNICIPAL INFORMATION
Records from the Police Department were checked by ______________________________ Title ____________________
Charges / Arrests / Incidents:
Date:
Disposition:
NO RECORD
NO AGENCY RESPONSE
Date Checked __________
Records from the Municipal Court were checked by ________________________________ Title ____________________
Charges / Arrests / Incidents:
Date:
Disposition:
NO RECORD
NO AGENCY RESPONSE
Date Checked __________
STATEWIDE INFORMATION
(Please check all counties)
OSCN
ODCR
Date Checked _________
were checked by
Title
ANY PROTECTIVE ORDERS (PO) OR BENCH WARRANT(S) CURRENTLY IN EFFECT
YE S
NO
ANY CRIMINAL MISDEMEANOR (CM) OR CRIMINAL FELONY (CF) CASE FILINGS
YE S
NO
Please attach any relevant supporting documents and forward with the SDA application within 14 days of the date received.
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