Form Dpssp 4645 – Fill Out and Use This PDF

Louisiana Department of Public Safety and Corrections

Office of State Police

Louisiana Concealed Handgun Permit

Application Packet

Submit applications to: Concealed Handgun Permit Unit, P.O. Box 66375, Baton Rouge, LA 70896

If you have questions you may contact the Concealed Handgun Permit Unit by telephone at (225) 925-4867, by fax (225) 922-0225, by mail : P.O. Box 66375, Baton Rouge, LA 70896, or by email: concealed.handguns@dps.la.us

Information can also be found at www.lsp.org/handguns.html

GENERAL INFORMATION AND INSTRUCTIONS

Please read and follow instructions carefully. Failure to submit application correctly will result in processing delays.

1.CONCEALED HANDGUN PERMIT LAW – LRS 40:1379.3

a)All applicants must read this law and swear to this fact. The statute contains the eligibility requirements to receive a concealed handgun permit as well as the rules and regulations regarding the code of conduct of permittees.

b)A copy of the “Louisiana Concealed Handgun Permit Laws, Administrative Rules and Selected Statutes” can be found at www.lsp.org/handguns.html

2.APPLICATION PROCESSING FEES (New and Renewal Applications)

ALL FEES ARE NON-REFUNDABLE

a)	45 Day Temporary permit	- $25.00 (Balance must be paid upon approval of 5 year or Lifetime permit)
b)	5 year permits	- $125.00	(65 years and older or active duty military personnel - $62.50)
c)	Lifetime permits	- $500.00	(65 years and older or active duty military personnel - $250.00)

d)*NOTE* Effective August 1, 2016 Act 44 of the 2016 Louisiana Legislative Session exempts HONORABLY DISCHARGED veterans of the U.S. armed forces from all fees associated with 5-year or lifetime concealed handgun permits. This Act doesn’t affect currently active military personnel. Active duty personnel remain eligible to receive the half price discount with a copy of your most recent orders

e)*Note* If any applicant has not continuously resided in Louisiana for the past 15 years an additional $50.00 fee is required (HONORABLY DISCHARGED VETERANS ONLY are exempt from this fee).

f)A fee schedule is listed in the “Louisiana Concealed Handgun Permit Laws, Administrative Rules and Selected Statute.” Initial application fees are found in LAC 55:I:1307.B.15. Renewal application fees are found in LAC 55:I:1307.D.2.

g)Fees are payable to the Louisiana Department of Public Safety and Corrections in the form of a cashier’s check, certified check or money order. Personal checks and cash are not accepted.

h)*Note* Online applicants will receive a confirmation email upon submission of their application and another email upon acceptance of their application. The acceptance email will contain a link to submit a credit card payment. If payment is not made within thirty (30) days, the application will be purged from the system and will require a new submission to proceed.

3.FIREARMS TRAINING REQUIREMENTS

a)Louisiana law states that an applicant shall demonstrate competence with a handgun.

b)Applicants must provide a copy of proof of training with their original (5yr or lifetime) or renewal application.

c)Lifetime permit holders will have to provide proof of recertification training every 5 years.

d)Approved firearms safety training tuition costs vary by organization and are not regulated by the DPS&C.

e)A list of approved instructors can be found at www.lsp.org/handguns.html

f)Original Applications-Specific modes of demonstrating competence are listed in LRS 40:1379.3 (D)(1) and also in LAC 55:I.1311.A.

g)Renewal Applications-Specific modes of demonstrating competence are listed in LAC 55:I.1311.B.

h)Training for both applications shall include:

instruction on handgun nomenclature and safe handling;

instruction on ammunition knowledge and fundamentals of pistol shooting;

instruction on handgun shooting positions;

instruction on the use of deadly force and conflict resolution which shall include a review of R.S. 14:18 through 14:22 and which may include a review of any other laws relating to the use of deadly force;

instruction on child access prevention; and

actual live range fire and proper handgun cleaning procedures.

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GENERAL INFORMATION AND INSTRUCTIONS (continued)

4.GENERAL APPLICATION INFORMATION

a)You must submit a “New” permit application if:

This is the first time you have applied for a permit in Louisiana.

Your previous permit has been expired for more than 60 days.

Your previous application was denied or your permit was revoked.

b)Submit the completed, original application form included in this packet. Please print legibly or type the data in the form fields. Do not send photocopied or double sided applications. Affidavits must be notarized within sixty (60) days of the application date.

c)For purposes of obtaining a permit, “resident” is defined in LRS 40:1379.3(J)(3) and LAC 55:I:1305.

For proof that an applicant has resided within this state prior to his/her application for a permit, the applicant shall submit with the application a photocopy of their valid Louisiana driver’s license or Louisiana identification card.

d)Photocopies of any other documentation, if required, MUST clearly show all names, signatures and other pertinent information. Copies which are too dark or too light and do not show all pertinent information cannot be accepted. DO NOT

SEND ORIGINALS, UNLESS SPECIFICALLY REQUIRED TO DO SO, AS THEY CANNOT BE RETURNED.

e)Fingerprint Cards - Fingerprint cards must be signed and filled out completely, including your name and signature, address, date of birth, place of birth, social security number (SSN – see below) and your physical characteristics (sex, race, height, etc.).

Two (2) fingerprint cards must be submitted. Both cards must be legible. Fingerprints should be taken/rolled by trained fingerprint technicians on a complete, legible, and classifiable FBI applicant fingerprint card by a person employed by a law enforcement agency. Fingerprint cards that are not legible will be returned to the applicant and will cause a delay in processing the application.

Note: When being printed on AFIS, you must have your prints taken twice (do not print the same set twice). When prints are done with ink, you must submit two different cards.

The social security number (SSN) is requested on the application in order for the Department of Public Safety and Corrections to fully conduct a criminal history background check on all applicants as required by law. The social security number will be used for Criminal Justice purposes only. Such information will be utilized to verify identification and ensure that applicants have no arrests, convictions, or warrants that would make them ineligible for a permit. Inclusion of your social security number is optional and will not constitute grounds for denial. However, verification of your eligibility to carry a concealed handgun is not optional. As such, failure to include the social security number may result in a delay of approving your application.

f)Marital Status – If you have ever been divorced, you must provide the department with a copy of the divorce settlement, decree, or final judgment along with any other orders or injunctions of the court. Failure to include this information will result in the delay of your application. If you are submitting this application as a Renewal, and you have previously submitted this information, it is not necessary to include in your application again.

g)Criminal Offense, Arrests, Detentions and Litigation - Criminal Offense: an act punishable by law. If you have ever been arrested, charged, detained, indicted, or summoned for any criminal offense or violation, EVEN THOSE CHARGES WHICH YOU

BELIEVE TO HAVE BEEN DROPPED, DISMISSED, NOLLE PROS, EXPUNGED, etc.., you must answer “YES” to the arrest questions (Question #7) and submit certified true copies of the final court disposition of the case with your application. You must list all violations of law or municipal ordinances, except those such as traffic violations (speeding, red light, expired license, etc.). Failure to answer this question correctly will result in the denial of your application.

FAILURE TO LIST ALL ARRESTS, DETENTIONS, AND LITIGATION MAY RESULT IN DELAY OR DENIAL OF THE PERMIT, AND OTHER CRIMINAL PENALTIES AS ALLOWED BY LAW. NOTE: The issuance of a Citation or Summons is an arrest and must be listed.

You must still list violations that were EXPUNGED, DISMISSED, or SET ASIDE through either Article 893, Article 894, R.S. 40:983, or for which you were PARDONED and you must provide certified documentation of each arrest with your application.

h)Military Service - If you have served in the Armed Forces of the United States, you must include a copy of your Department of Defense Forms 214, 256 or 257 (type of discharge must be listed). If you are currently in the military and are using the military discount, you must include a copy of your most recent orders or a copy of your military ID, if allowed. (for LAARNG, as noted in 1.8.1.1. “the cardholder may allow photocopying of their ID card to facilitate DoD benefits”)

i)Medical Information - If you answered “yes” to any of the medical questions #13-19, the Medical Summary must be completed by the treating physician or your Medical Doctor (no Physicians Assistants). This information MUST be included with your application.

Department of Public Safety and Corrections

Office of State Police

Concealed Handgun Permit Unit

P.O. Box 66375 Baton Rouge, LA 70896

www.lsp.org/handguns.html

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This application will not be processed unless completed in its entirety and submitted along with all supporting documents and application fees.

Application Type						Current GP # (Renewal Only)					For Office Use Only
NEW PERMIT - 5 YEAR					45 DAY
NEW PERMIT – LIFETIME				PERMIT
RENEWAL to 5 YR PERMIT				for permanent		DATE:					PARISH OF RESIDENCE
RENEWAL to a LIFETIME				injunction or
				protective order
LEGAL NAME (LAST, FIRST, MIDDLE)											MAIDEN NAME
LIST ANY ALIASES OR LEGAL NAME CHANGES											EMAIL ADDRESS
RACE	ASIAN/PACIFIC ISLANDER					BLACK			UNKNOWN		HOME PHONE NUMBER
	NATIVE AMERICAN/ALASKAN NATIVE					WHITE
SEX	HEIGHT	WEIGHT			EYE COLOR	HAIR		DATE OF BIRTH			DAYTIME/BUSINESS PHONE NUMBER
FEMALE						COLOR
MALE
SOCIAL SECURITY NUMBER (SSN)					DRIVERS LICENSE NUMBER					STATE	LA IDENTIFICATION CARD NUMBER
PLACE OF BIRTH (City, State, Country)					ISSUE DATE OF D/L OR ID CARD					EXPIRATION DATE OF D/L OR ID CARD
CURRENT PHYSICAL ADDRESS (STREET ADDRESS)						CITY				STATE	POSTAL ZIP CODE
CURRENT MAILING ADDRESS (STREET/PO BOX)						CITY				STATE	POSTAL ZIP CODE

How long have you lived at your current address? From _______________________ to present.

Previous residences – Complete this section if you have not lived at your current address for the fifteen (15) years preceding the date of this application. Attach separate page if necessary.

ADDRESS

CITY

STATE

DATES

FROM

TO

NAME OF COMPANY/BUSINESS/FIRM, ETC.

ADDRESS

PLACE OF

EMPLOYMENT

CITY

STATE

POSTAL CODE

NAME OF SUPERVISOR

CONTACT NUMBER

MARITAL STATUS

SINGLE

MARRIED

DIVORCED

WIDOWED

IF EVER DIVORCED PLEASE

(Check all that currently apply)

PROVIDE DIVORCE DECREE

OFFICE USE ONLY

DATE ENTERED

CHECK NUMBER

RECEIPT NUMBER

INITIALS

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ALL APPLICANTS: PLEASE ANSWER “YES” OR “NO” TO ALL QUESTIONS BELOW. Read each question carefully. If you make an error, cross out the incorrect choice and initial the change. If you answer “Yes” to questions 7-12, attach certified true copies of the court documents, or “Yes” to questions 13-19, have the treating physician complete the medical summary disposition form.

ARRESTS, DETENTIONS, AND LITIGATION

If you answered “Yes” to questions 7-12, provide details below and attach certified true copies of documentation to prove disposition. If additional space is needed, attach a signed statement providing the requested information listed below.

MILITARY SERVICE

MEDICAL INFORMATION

If you answered “Yes” to questions 13-19, provide details below and attach a completed medical summary form from your treating physician.

ADDITIONAL INFORMATION

USE THE SPACE BELOW FOR INFORMATION RELATING TO THE FOLLOWING:

Questions 7-12 (Arrests), Questions 13-19 (Medical) or Question 20 (Permit Status)

Attach additional sheet if necessary

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STATE OF LOUISIANA

PARISH OF ________________________

BEFORE ME, the undersigned Notary Public, duly commissioned and qualified, in and for the Parish and State aforesaid, personally came and appeared:

Affiant’s Name (Printed)

Affiant’s Address (Printed)

Who being by me first duly sworn, deposed and said:

I, ______________________________, pursuant to R.S. 40:1379.3, agree to indemnify and hold

harmless the state of Louisiana, the Department of Public Safety and Corrections, the Secretary and the Deputy Secretary of the Louisiana Department of Public Safety and Corrections, and any of its agents or employees, and any peace officer within this state, from and against any and all liability, claims, actions, fines or losses of any kind or nature, including costs and attorney’s fees, in any way arising out of, connected with or related to the issuance or use of my Louisiana Concealed Handgun Permit.

____________________________________

Affiant’s Signature

SWORN TO AND SUBSCRIBED BEFORE ME ON THIS ___________ DAY OF _____________, _________

_________________________________________	_________________________________
Print, Type, or Stamp Name of Notary Public	Notary Public

MY COMMISSION EXPIRES _____________________________________

Affidavits are valid for sixty days after notarization.

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STATE OF LOUISIANA		PARISH OF ________________________
TO:	Any physician, psychologist, social worker, hospital, clinic, or other health care provider, law enforcement

Agency or officer, any branch of the Armed Forces of the United States, or any individual or institution having information about me.

BEFORE ME, the undersigned Notary Public, duly commissioned and qualified, in and for the Parish and State aforesaid, personally came and appeared:

Affiant’s Name (Printed)

Affiant’s Address (Printed)

Who being by me first duly sworn, deposed and said:

I, _________________________, do hereby give my consent in authorizing full disclosure and review of all

records and information, verbal or written, concerning myself to any duly authorized agent of the Louisiana Department of Public Safety and Corrections, Office of State Police, Concealed Handgun Permit Section, whether said records are public, private, confidential, or privileged in nature. I further understand that if any of the records obtained are confidential or privileged, the Louisiana Department of Public Safety and Corrections will maintain the privilege or confidentiality of such records.

The intent of this authorization is to give my consent for full and complete disclosure of any and all medical, criminal, or other personal information regarding me, including but not limited to physical, psychiatric, or substance abuse treatment and/or consultation records, and all records pertaining to my conduct such as background reports, criminal history records, etc. I further understand that this release will only be used to obtain information for the purpose of determining my eligibility for a Louisiana Concealed Handgun Permit.

I understand that any information obtained through a medical or personal history background investigation which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my eligibility for a concealed handgun permit. I also certify that any person(s) who may furnish such information concerning me shall not be held liable for giving this information, and I do hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information.

I also understand that a reproductive copy of this release affidavit shall be for all intents and purposes as valid as the original. I request and appreciate your full cooperation.

This release shall be and remain valid from the date of execution until the expiration or revocation of any concealed handgun permit issued to me pursuant to this application, or until my application for a concealed handgun permit has been denied pursuant to a final judicial decision.

	____________________________________
	Affiant’s Signature
SWORN TO AND SUBSCRIBED BEFORE ME ON THIS __________ DAY OF _____________, _________
_________________________________________	_______________________________
Print, Type, or Stamp Name of Notary Public	Notary Public

MY COMMISSION EXPIRES _____________________________________

Affidavits are valid for sixty days after notarization.

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