Form 12-299a - Application For A New Concealed Handgun Permit - Alaska Department
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1
2ALASKA
APPLICATION FOR A NEW
Do not write in this space
DEPARTMENT OF PUBLIC SAFETY
CONCEALED HANDGUN
Division of Alaska State Troopers
PERMIT
Please type or print using black ink
This application will not be processed unless all applicable questions are answered
and the required training certificate, photograph, fingerprint cards, and application
fee accompany the application.
THE APPLICATION FEE IS NON-REFUNDABLE.
Section I.
ALASKA DRIVERS LICENSE OR
Department use only
DATE OF BIRTH
PLACE OF BIRTH (CITY/STATE or CITY/COUNTRY)
IDENTIFICATION NUMBER
APSIN NUMBER
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX
(NMN if no middle name or MIO if initial only)
(Jr, Sr, II, III)
HEIGHT
WEIGHT
HAIR COLOR
EYE COLOR
RACE
GENDER
DAYTIME TELEPHONE NUMBER
FT.
IN.
Home
Work
Cell
MAILING ADDRESS
CITY
STATE
ZIP CODE
RESIDENCE ADDRESS (IF DIFFERENT THAN ABOVE)
CITY
STATE
ZIP CODE
How long have you lived at your current address? From ____________________________ to present.
(Date)
Previous residences – Complete this section if you have not lived at your current address during the five years preceding the
date of this application. Attach a separate page if necessary.
CITY
STATE
DATE(S)
Yes
No
Have you ever applied for or been issued an Alaska Concealed Handgun permit? If yes, provide information
and if necessary, attach a signed statement with an explanation.
Section II. Read each question carefully. If you make an error, cross out the incorrect choice and initial the change. If you answer
“no” to questions 1-4, or “yes” to questions 5-14, attach court documents or a signed statement explaining your answers.
1.
Are you 21 years of age or older?
Yes
No
2.
Are you eligible to own or possess a firearm under the laws of this state and federal law?
Yes
No
3.
Are you a resident of Alaska and have you been a resident of the state for the 90 days immediately
Yes
No
preceding this application?
4.
Have you demonstrated competence with handguns as provided in AS 18.65.715?
Yes
No
5.
Have you been convicted of two or more class A misdemeanors of this state or similar laws of another
jurisdiction within the six years immediately preceding this application? See General Information and
Yes
No
Instructions for definition of “conviction.”
6.
Are you now in, or have you been ordered by a court within the last three years to complete an alcohol or
Yes
No
substance abuse treatment program?
7.
Are you under indictment or information for, or have you been convicted in any court of a crime punishable
Yes
No
by imprisonment for a term exceeding one year?
8.
Are you the subject of a domestic violence injunction under AS 18.66.100 that was issued after a hearing
Yes
No
for which you received notice and had an opportunity to participate?
9.
Have you ever been convicted in any court of a misdemeanor crime of domestic violence?
Yes
No
10. Are you a fugitive from justice?
Yes
No
11. Are you an unlawful user of, or addicted to any controlled substances?
Yes
No
12. Have you been adjudicated a mental defective or been committed to a mental institution?
Yes
No
13. Are you an alien who is residing in the United States illegally or a former citizen of the United States who
Yes
No
has renounced your citizenship?
14. Have you been discharged from the armed forces under dishonorable conditions?
Yes
No
12-299A (Rev. 10/00)
Concealed Handgun Permit Application
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