Application For A License To Carry A Concealed Deadly Weapon - Superior Court Of The State Of Delaware

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Superior Court of the State of Delaware
Application for a License to Carry a Concealed Deadly Weapon
Please file original and one (1) copy of all documents, together with the filing fee.
Also attach two (2) current color passport-style photographs.
New
Renewal
Retired Police Officer
CCDW License #
New Castle
Kent
Sussex
County in which you are applying
Full Name
Last
First
Middle
Suffix
Ad dr e s s
Street
City
State
Zip
Phone Numbers
Home
Work
Cell
Identifying Information
US Citizen
Yes
No
Driver’s License or State ID
Social Security Number
Date of Birth
Place of Birth (City)
Place of Birth (State)
Sex
Height
Weight
Eye Color
Hair Color
Race
Employment Information
Occupation
Employer Phone
Name of Employer
Employer Address
Street
City
State
Zip
( P l a c e o f B u s i n e s s )
Reason for Application (Be VERY Specific)
Do you hold a permit in another state?
Yes
No
If yes, which state?
Have you ever been denied a permit?
Yes
No
If yes, which state?
Date
Yes
No
Have you ever been convicted of any alcohol related offense?
If yes, list date(s), place(s) offense(s) and sentence(s)
1
2
Yes
No
Have you ever been convicted in this State or elsewhere of a felony or a crime of violence involving physical injury to another,
whether or not armed with or having in your possession any weapon during the commission of such felony or crime of violence?
Yes
No
Have you ever been committed for a mental disorder to any hospital, mental institution, or sanitarium?
Yes
No
If yes, do you possess a certificate of a licensed medical doctor or psychiatrist that you no longer suffer from a mental disorder
which interferes or handicaps you from handling deadly weapons?
(If yes, attach certificate)
Yes
No
Have you ever been convicted for the unlawful use, possession, or sale of a narcotic, dangerous drug, or central nervous system
depressant or stimulant?
Yes
No
Have you ever been, as a juvenile, adjudicated as delinquent for conduct which, if committed by an adult, would constitute a
th
felony?
(A response to the question is not required if you have reached your 25
birthday)
IF ADDITIONAL SPACE IS NEEDED, ATTACH A SEPARATE SHEET
Revised 03/2015

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