Application For License To Carry Concealed Handgun
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2Columbia County Sheriff’s Office
Jeffrey M. Dickerson
Concealed Handgun Licensing Unit
Columbia County Sheriff
901 Port Ave.
St. Helens, OR 97051
CHL UNIT - 503-366-4651
APPLICATION FOR LICENSE TO CARRY CONCEALED HANDGUN
*** Fees are non-refundable and cover the cost of background investigation and processing required by law***
Currently Appointments are Required
G
G
New Applicant
Renewal
County Transfer
Address Change
Out of State New Applicant
Out of State Renewal
$65.00
$50.00
$30.00
$15.00
$75.00
$60.00
Full legal name: __________________________________________________________
Last
First
Middle
Other Names Used (Maiden etc) _________________________________________________ __
Current Residence/Address:
G I currently live in a contiguous state and am applying as an out of state applicant. Please provide a
.
Statement on a separate piece of paper indicating a compelling need for a CHL in Columbia County
Mailing Address (if different)
P.O. Box
City
State
Zip
EMAIL ADDRESS FOR SHERIFF’S OFFICE USE ONLY
NOTE: Your Oregon Drivers License / ID card must reflect your current Columbia County address
Home Phone Number/Messsage:___________________
Work/Cell Number:____________________________
Employer:______________________________________
Occupation:__________________________________
Address: ______________________________________
City:________________________________________
Driver’s License Number: _________________________
Expiration: ___________________________________
Date of Birth: __________ Height: ____
Weight: ____
Eye Color: ______ Hair Color _____
Social Security Number ____________________ (Disclosure of your social security number is voluntary. Solicitation of the
number is authorized under ORS 166.291. It will be used only as a means of identification.)
State of Birth (or Foreign Country): _______________________
If you w ere born in a foreign country, you must provide proof of citizenship or naturalization. Exceptions are if
you w ere born in a US Territory such as Guam or US Virgin Islands (St. Thomas, St. Croix, St. John) or a
commonw ealth such as Puerto Rico or Northern M ariana Islands.
I am a legal resident alien who can docum ent continuous residency in Colum bia County for at least six
m onths. I have declared in writing to the Im m igration and Naturalization Service m y intention to becom e a
citizen. I can produce the proof of receipt with a copy of the N-300 or N-400 form .
List residence addresses for the past 3 years:
1._____________________________________________________________________________
2._____________________________________________________________________________
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