Form Wp3 - Application For Iowa Permit To Acquire A Pistol Or Revolver printable pdf download

APPLICATION FOR IOWA PERMIT TO ACQUIRE A PISTOL OR REVOLVER

 Five year Permit to Acquire a Pistol or Revolver

 Duplicate of previously issued Permit to Acquire a Pistol or Revolver

NAME

DATE OF BIRTH

Last

First

Middle

Month

Day

Year

SEX (circle one)

MALE

FEMALE

SOCIAL SECURITY NUMBER (optional)

RESIDENCE

ADDRESS

Number

Street

Apt/Unit #

City

State

Zip Code

MAILING ADDRESS  Same as residence address (skip mailing address section below)

 Different than residence address (complete mailing address section below)

MAILING

ADDRESS

Number

Street (or PO Box number)

Apt/Unit #

City

State

Zip Code

COUNTRY OF CITIZENSHIP

IF NOT U.S. CITIZEN: USCIS, ARN, OR I-94 ADMISSION NUMBER

DRIVER’S LICENSE OR NON-OPERATOR ID #

DRIVER’S LICENSE OR ID STATE OF ISSUANCE

PRIMARY PHONE

ALTERNATE PHONE (optional)

ALIASES (list all other

names ever used)

PERMIT ELIGIBILITY

YES NO



1. Do you have charges pending for a felony?



2. Have you ever been convicted of a felony?



3. Have you ever been adjudicated delinquent for an offense that would be a felony if committed by an adult?



4. Have you ever been convicted of an offense involving a firearm or explosive that is classified as a misdemeanor AND is

punishable by more than one year of imprisonment (such as an Iowa aggravated misdemeanor)?



5. Have you ever been convicted of a misdemeanor crime of domestic violence?



6. Are you subject to a court order restraining you from harassing, stalking, or threatening your intimate partner, your

child, or the child of your intimate partner?



7. Are you currently on probation for any offense? IF YES list the offense for which you are serving probation:



8. Are you a fugitive from justice?



9. Have you been dishonorably discharged from the Armed Forces?



10. Have you ever renounced your United States citizenship?



11. Have you unlawfully used any controlled substance in the previous 12 months?



12. Has a court, board, commission, or other lawful authority ever found you to be a danger to yourself or others?



13. Has a court, board, commission, or other lawful authority ever ordered you to receive treatment for mental health

reasons, or for other reasons, such as drug abuse?



14. Has a court, board, commission, or other lawful authority ever found you to be incompetent to conduct your affairs?



15. Have you ever been found incompetent to stand trial for any offense?



16. Have you ever been found not guilty by reason of insanity for any offense?



17. Are you a citizen of the United States?

Please provide relevant information about your responses to questions 1-17, such as having been granted a pardon, a special

COMMENTS

restoration of citizenship rights with firearms rights, an order granting “Relief from Disabilities,” or other relevant information:

Form WP3 – Published by Iowa Department of Public Safety

Page 1 of 2

Form for use on or after 09/01/2017, Version 1

Form Wp3 - Application For Iowa Permit To Acquire A Pistol Or Revolver

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