Form 12-299a - Application For A New Concealed Handgun Permit - Alaska Department (Page 2 of 2) in pdf

Section III.

WARNING:

SUPPLYING A FALSE STATEMENT, ANSWER, OR DOCUMENT THE APPLICANT DOES NOT BELIEVE TO BE TRUE

MAY SUBJECT THE APPLICANT TO CRIMINAL PROSECUTION FOR UNSWORN FALSIFICATION UNDER ALASKA STATUTE 11.56.210.

IF FOUND GUILTY, THE APPLICANT MAY BE PUNISHED FOR VIOLATION OF A CLASS A MISDEMEANOR, AND IN SUCH CASES THE

PERMIT WILL BE REVOKED AND THE APPLICANT MAY BE BARRED FROM ANY FURTHER APPLICATION FOR A PERMIT.

I HEREBY STATE UNDER PENALTY OF LAW THAT:

I have read AS 18.65.705 and qualify to apply for a concealed handgun permit;

I have been furnished with a copy of the state laws and regulations relating to concealed handguns and have read and

understand them;

I want a permit to carry a concealed handgun for lawful purposes, which may include self-defense;

The information in this application and any documents submitted with this application is true, correct, and complete to the

best of my knowledge and belief; and

I understand a permit eligibility investigation will be conducted as part of the application process; this may involve

computerized records searches and I authorize the investigation.

Date

Signature of applicant

Full name (clearly printed or typed)

Instructions to applicant: Review the application, fingerprint cards, photograph, and attachments

carefully. Failure to submit a properly completed application will result in a delay in processing your

application.

Use the checklist below as a reminder that you have included all the necessary forms and

documents. Mark the box to the left of an item as you place it in the envelope to take to the Alaska State Trooper

office or the office of an approved police department.

Applicant Checklist

Application (page 1)

Application (page 2)

Photograph

Fingerprint cards

Training certificate

Attachments

$99 fee

FOR DEPARTMENT USE ONLY

RECEIPT FOR FEES PAID

The Department of Public Safety acknowledges that

, the sum of $

was received by:

(Date)

CASH

CHECK No. ____________

MONEY ORDER No. ___________________

___________________________________________

_________________________________________________

Signature of employee accepting application

Printed or typed name of employee accepting application

Instructions to department employee or employee of an approved police department receiving the

application. Use the checklist below to mark items in the packet before forwarding the application packet to the

Permits and License Unit. The applicant turning in this document must show to you a valid Alaska Driver’s

License or Alaska Identification Card. When the fee is paid, complete the Receipt For Fees Paid. If the

applicant provides you with a copy of this page, complete the receipt information and give the copy to

the applicant.

Receiving Office

Alaska OL or ID verified

Training certificate

Photograph

Application (page 1)

Application (page 2) signed

Fingerprint cards completed

and dated

correctly and signed

$99 fee

Attachments

Receipt

12-299A (Rev. 10/00)

Concealed Handgun Permit Application

Form 12-299a - Application For A New Concealed Handgun Permit - Alaska Department Page 2

Related Articles

Related forms

Related Categories