HALE COUNTY SHERIFF'S OFFICE ELECTRONIC PISTOL PERMIT APPLICATION

  • STATE OF ALABAMA

    Read the following carefully and provide complete and accurate information. It is a crime to make a false statement or report to law enforcement. (Title 13A-10-109, Code of Alabama, 1975). A criminal history background check will be conducted on each applicant.

  • Full Name*
  • Other Names You Have Been Known By
  • Physical Address*
  • Mailing Address*
  • Email Address*
  • Home Phone Number*
  • Cell Phone Number*
  • Age*
  • Date of Birth*
  • Place of Birth*
  • Are You A U.S Citizen?*
  • Sex*
  • Race*
  • Height*
  • Weight*
  • Hair Color*
  • Eye Color*
  • Driver's License Number*
  • Driver's License State*
  • Other State I.D
  • Social Security Number*
  • Employer*
  • Employer's Address
  • Employer's Phone Number
  • Have you ever had a pistol permit revoked or denied?*
  • If so, where and when
  • Have you ever been arrested for a crime of violence?*
  • Have you ever been taken into custody by a law enforcement agency?*
  • Have you ever been charged with a crime?*
  • Are you currently under an indictment?*
  • Have you ever been treated for a mental illness?*
  • Have you ever been treated for substance abuse (drugs / alcohol)?*
  • Are you addicted to alcohol, prescription medication or illegal drugs?*
  • Are you on probation or under a restraining order from ANY court?*
  • Are you awaiting trial as a defendant in any criminal case?*
  • Have you been found guilty, but mentally ill in a criminal case?*
  • Have you been found not guilty in a criminal case by reasons of insanity or mental disease or defect?*
  • Have you been declared mentally incompetent to stand trial in a criminal case?*
  • Have you asserted a defense in a criminal case of not guilty by reason of insanity or mental disease or defect?*
  • Have you been found not guilty by reason of lack of mental responsibility under the Uniform Code of Military Justice?*
  • Have you required involuntary outpatient treatment in a psychiatric hospital or similar treatment facility based on a finding that you are an imminent danger to yourself or to others?*
  • Have you required involuntary commitment to a psychiatric hospital or similar treatment facility for any reason, including drug use?*
  • Have you been the subject of a prosecution or of a commitment or incompetency proceeding that could lead to a prohibition on the receipt or possession of a firearm under the laws of the State of Alabama or the United States*
  • If your answered YES to any of the questions above, please use the space below to provide dates and places of arrests or treatment, charges, agency of arrest, and dispositions:
  • I CERTIFY THAT MY ANSWERS ARE TRUE, COMPLETE AND CORRECT AND I UNDERSTAND THIS APPLICATION WILL BE REJECTED IF ANY INFORMATION IS FOUND TO BE FALSE OR MISLEADING. PLEASE TYPE YOUR SIGNATURE BELOW*
  • DO NOT WRITE BELOW - FOR OFFICIAL USE ONLY

    Approved_____ Not Approved_____

  • Sheriff's Signature:_____________________________

  • NCIC___ ACJIC___ NICS___ TRANSACTION#___________________ OTHER:______________________

  • Security Code*

     

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