Adams County Colorado Concealed Permit Form – Fill Out and Use This PDF

ADAMS COUNTY SHERIFF'S OFFICE

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				New or Renewal?		Permit number if renewal			Current Expire Date	County of issue
Regular	Temporary/emergency			New	Renewal					ADAMS
Applicant's Name (LAST, FIRST, MIDDLE)										Colorado Resident?
										Yes	No
Other Names (Nickname, maiden name, alias, etc.)										Date of Birth (MM/DD/YYYY)
Social Security Number *				Colorado County of Residence**				E-Mail (Voluntary-assists us in contacting you discreetly)***
Current Home Address							City/State/Zip			Area Code + Home Phone***
Mailing Address if different from above							City/State/Zip			Other phone-Area Code + Home Phone***
Length of time at current address			If at current address less than 10 years, List all previous addresses for the past 10 years. Attach seperate sheet if additional space is needed
		1
2						3

*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 a 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 seperate 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 or quickly clear up any issues or questions.

Applicant History - If you answer "yes" to questions one through fourteen, 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. Legibly print or type all information. Attachments must be clearly legible. Concerning "conviction", answer "no" if pardoned or if the conviction has been expunged, sealed or set aside.

PROOF OF FIREARMS TRAINING

Please check one pertaining to your application submittal

A training certificate from a handgun training class (as defined in C.R.S. 18-12-202.5) obtained within the ten years preceding submittal of this application. It must be the original training certificate or a photocopy that includes the original signature of the class instructor.

Proof of honorable discharge from a branch of the United States Armed Forces (DD214) within the three years preceding submittal of this application

Proof of honorable discharge from a branch of the United States Armed Forces (DD214) that reflects pistol qualifications obtained within the ten years preceding submittal of this application.

Evidence that, at the time this application is submitted, the applicant is a certified instructor.

Evidence of experience with a firearm through participation in organized shooting competitions or current military service.

A certificate showing retirement from a Colorado Law Enforcement Agency that reflects pistol qualification obtained within the ten years preceding submittal of this application.

NOTICE OF DISCLAIMER AND PERSONAL INQUIRY WAIVER

NOTE TO RECIPIENT A PHOTOCOPY OF THIS SIGNED REQUEST SHALL BE FOR ALL INTENTS AND PURPOSES, AS VALID AS THE ORIGINAL. YOU MAY RETAIN THIS FORM IN YOUR FILES. THE ORIGINAL OF THIS FORM WILL REMAIN IN THE SHERIFF'S OFFICE CONCEALED HANDGUN PERMIT FILES.

Handguns have been classified by both Federal and Colorado law as deadly weapons. They are capable of causing death, serious injury, and property damage. I certify that I have read and understand the information provided in the application packet and the attached Colorado Revised Statutes pertaining to the use of deadly physical force, and agree that any violation will be cause for revocation of this permit.

By issuing this permit, the issuing County Sheriff, Sheriff's Office County, County Sheriff's of Colorado and employees shall not be held liable or responsible for the manner in which the permit holder used the concealed handgun or the results of said use, including, but not limited to, the death of, or injury to, any person or damage to any property resulting from directly or indirectly from the intentional, reckless, negligent or accidental discharge of a handgun, or any criminal acts committed by the permit holder involving the use of the concealed handgun. Furthermore, the issuing County Sheriff's Office in no way stands as Warrantor or Guarantor of the structural, mechanical or functional fitness of the concealed handgun for any purpose whatsoever.

By signing this application, I acknowledge and accept the terms contained in the notice of disclaimer. I hereby certify that all statements made by me in the completion of this application are, to the best of my knowledge, accurate and true. I understand that any false answer (deceitfully made) or any fraud whatsoever constitutes a basis for rejection of this application with no further consideration. If fraud and/or deceit is subsequently discovered, such fraud and/or deceit will become grounds for rejection of this application and may result in criminal charges.

I fully understand that the issuing County Sheriff's Office conducts a background investigation of all applicants who are being considered for a concealed handgun permit. This investigation includes, but is not limited to, an investigation of military, police, driving records and character.

I hereby authorize any person who is contacted by the issuing County Sheriff's Office personnel to release any information to the issuing County Sheriff's Office pertaining to the background investigation including, but not limited to military, police and driving records and character for use by the issuing County Sheriff's Office in the consideration of my application.

I further agree to release and hold harmless, the issuing County Sheriff's Office, it's agencies, elected officials, officers, agents and employees from any and all liability or claims, which I may have arising out of the disclosure of such information to the issuing County Sheriff's Office in the consideration of my application.

This authorization for the release of information shall be valid for a six (6) month period from the date hereof. Any release of claims or liability set forth herein shall survive the termination of the agreement.

The applicant swears, under oath, that the contents of the permit application and the information contained in the permit application is true and correct.

Applicant's Signature __________________________________________ Subscribed and sworn before me this _______day of __________________, ____________

Witness my hand ____________________________________________________________

Sheriff or designee

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