Application For Concealed Handgun Permit Page 4
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4CRIMINAL BACKGROUND INVESTIGATION
(
)
THIS SPACE FOR LAW ENFORCEMENT USE ONLY
YES
NO
PENDING CHARGES
CONVICTIONS
,
(
)
IF YES
SEE ATTACHMENT
S
/
/
,
OFFICER OR AGENCY DESIGNEE
MONTH
DAY
YEAR
(
)
THIS SPACE FOR COURT USE ONLY
.
RESIDENT PERMIT FILE NO
CIRCUIT COURT
APPLICATION OF
________________
:
ON
FOR A VIRGINIA RESIDENT CONCEALED HANDGUN PERMIT IS HEREBY
(
)
DATE
GRANTED
DENIED
(
)
SEE EXPLANATION BELOW
:
THE PERMIT APPLICATION IS DENIED ON THE BASIS OF THE FOLLOWING
.
YOU ARE ENTITLED TO AN ORAL HEARING BEFORE THIS COURT
THE REQUEST FOR A HEARING MUST BE FILED
-
.
WITH THIS COURT WITHIN TWENTY
ONE DAYS OF DENIAL OF YOUR APPLICATION
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3
SEE NOTICE
PAGE
/
/
,
JUDGE
MONTH
DAY
YEAR
(
)
THIS SPACE FOR STATE POLICE USE ONLY
.
NONRESIDENT PERMIT FILE NO
APPLICATION OF
:
FOR A VIRGINIA NONRESIDENT CONCEALED HANDGUN PERMIT IS HEREBY
GRANTED
DENIED
(
)
SEE EXPLANATION BELOW
3
3
SEE NOTICE
PAGE
/
/
,
SUPERINTENDENT
MONTH
DAY
YEAR
OR DESIGNEE
4
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