Concealed Handgun Permit Application printable pdf download

COUNTY SHERIFFS OF COLORADO

CONCEALED HANDGUN PERMIT APPLICATION

WARNING: The information you provide will be verified. Providing false information on this application constitutes a

criminal offense for which you may be prosecuted. Print or type all information except signatures.

Type of Permit Requested:

County of Issue:

□

LARIMER

□

New

Temporary/Emergency

Renewal Permit#: ___________

Applicant’s Name (Last, First and Middle):

□-

Resident of Colorado?

Other Names (nickname, maiden name, alias, etc.):

Date of Birth:

*Social Security Number:

**Colorado County of Residence:

EMAIL:

Current Home Address:

City/State/Zip:

***Area code + Home Phone:

Mailing Address if Different from Above:

City/State/Zip:

***Area code + Daytime Phone:

Length of Time at Current Address:

>If at current address for less than ten years, list all previous addresses for the past ten years:

(attach separate sheet of paper for additional space if needed)

*Social Security number is voluntary, but may assist in the background investigation in the event there are other individuals with a similar name who have had

contact with law enforcement authorities. It also helps to ensure that your record will never be accidentally merged with that of any other individual.

**If not a Colorado resident, please explain in a separate attachment why you need a permit and identify any property or business you own in Colorado.

*** Voluntary. This information will help us contact you if necessary to complete the application process.

Applicant History -

If you answer “yes” to questions 1-14, provide a detailed explanation on a separate sheet and attach it to this form. Where applicable

the information provided must include dates, locations, etc. Reference your explanations by preceding each with the number of the pertinent question. Print or

type all information. Attachment must be clearly legible. Concerning “conviction”; answer “no” if pardoned or if the conviction has been expunged, sealed or set

aside.

Have you been treated for alcoholism within the past ten years or ever been involuntarily committed as an alcoholic? ...............

-Y

-N

Have you had two or more alcohol-related convictions within the past ten years? ........................................................................... -Y

-N

Have you ever been convicted of perjury under C.R.S. Section 18-8-503? .................................................................................... -Y

-N

Are you currently the subject of either a criminal or civil restraining order? ...................................................................................... -Y

-N

Are you under indictment or information in any court for a felony, or any other crime, for which the judge could imprison you for

more than one year? ........................................................................................................................................................................ -Y

-N

Have you been convicted in any court of a felony, or attempt or conspiracy to commit a felony, or any other crime for which

the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation? ......... -Y

-N

Are you a fugitive from justice? ........................................................................................................................................................ -Y

-N

Are you an unlawful user of, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other

controlled substance? ....................................................................................................................................................................... -Y

-N

Have you ever been adjudicated mentally defective (which includes having been adjudicated incompetent to manage your

own affairs) or have you ever been committed to a mental institution? ............................................................................................ -Y

-N

10. Have you ever been convicted in any court of a misdemeanor crime of domestic violence as defined in the code

of Federal Regulations, subpart 478.11? ......................................................................................................................................... -Y

-N

11. Have you ever been adjudicated as a juvenile for a crime that would constitute a felony if committed by an adult or

attempt or conspiracy to commit a felony, under any state law or federal law? ............................................................................... -Y

-N

12. Have you ever been discharged from the Armed Forces under dishonorable conditions? ............................................................... -Y

-N

13. Have you ever renounced your United States citizenship? ............................................................................................................. -Y

-N

14. Are you of alien or non-citizen status in the United States? (if you answer “yes” please complete supplemental form) .................. -Y

-N

(form continued on other side)