Form Nsp1710 – Fill Out and Use This PDF

Nebraska State Patrol

Nebraska Concealed Handgun Permit

Application
	Type of	q New	q Personal Data Change
	Application	q Renewal	q Replacement - Lost/Stolen
	Permits reported lost or stolen will be immediately cancelled by the
	Nebraska State Patrol.
	Ofice Use Only - DCN _____________________________________

Please Type or Print Clearly. Incomplete applications will not be processed. In the event an applicant is found to have knowingly falsiied this application, or omitted pertinent information, that person may be subject to criminal prosecution.

4.	Social Security Number (Voluntary - See information below)			5. Nebraska Driver’s Licence Number/ State ID Number/ Active Military ID Number
6.	Physical Description Race	(Gender	Height	Weight	Hair Color	Eye Color)
7.	Current Residential Address	(Street, City, County, State, ZIP)			7a.Mailing Address (if different)		(Street, City, County, State, ZIP)

7b.Previous Residence (past 5 years)

NSP1710 (01-07)

*Pursuant to the Federal Privacy Act of 1974, we are requesting voluntary disclosure of the social security number from applicants for the sole purpose of processing criminal history background checks. This number is currently used in the system to assist in proper identiication when there are other individuals with the same name. A permit will not be denied solely because an individual declines to disclose his or her social security number. Applications not containing social security number may take signiicantly longer to process because other means may be required to ensure proper record identiication.

If replacement application, list date, location, and statement of facts and circumstances surrounding stolen or lost permit. Please include damaged permit, if available. _________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

I swear or afirm that the information I have provided on this application is complete and accurate.

Warning: Providing false identiication or false information on this application is a Class IV felony.

Signature ________________________________________

Acknowledgement

State of Nebraska

County of _______________________________________

The foregoing instrument was acknowledged before me this _______________ by

(date)

__________________________________________ .

(name of person acknowledged)

_____________________________

Notary Public Signature

Afix Seal Here

NSP1710 (01-07)

Concealed Carry Handgun Permit Information

Permit applicants who have successfully passed an approved training course will be required to visit one of the Nebraska State Patrol Troop Area Headquarters or the Criminal Identiication

Division in Lincoln to apply for a concealed handgun permit.

Applications forms will be available at each Troop Area Headquarters and on the Nebraska State

Patrol web-site at http://www.nsp.state.ne.us. Application forms can also be mailed from the

Criminal Identiication Ofice upon request by phoning 402-471-4545. Applicants are advised to obtain the application form in advance if possible because the form must be notarized, and notaries may not always be available at Troop Area Headquarters.

Troop A Headquarters

Troop D Headquarters

will be taken by the Nebraska State Patrol. Fingerprints of the applicant will be obtained at the time of application by utilizing the livescan equipment of the Nebraska State Patrol’s Automated

Fingerprint Identiication System (AFIS) if that equipment is available at the application site. If this equipment is not available, the applicant shall be ingerprinted on two legible ingerprint cards.

The applicable fee: The permit fee is $100.00. The fee shall be paid with the application and shall

be paid in cash or check made payable to the Nebraska State Patrol. When it becomes feasible,

payment may also be made with debit or credit cards approved by the Nebraska State Patrol.

If a permit is not issued to the applicant, the permit application fee will be refunded to the applicant

less the current charge for the required state and federal criminal history record check.

An application which is not complete or legible will not be processed. A notice of deiciency

will be mailed to the applicant who will have twenty (20) calendar days to submit information or documents to correct the deiciency. If the deiciency is not corrected within this time period,

the application and monies will be refunded to the applicant who will then have to reinitiate the application process to obtain a permit.

NSP1710 (01-07)

Applicant must submit the following at time of application:

qThe completed and notarized application form

qProof of training by providing either the original or a certiied copy of a certiicate of completion of a Handgun Training and Safety Course approved by the Nebraska State

Patrol. Requirements for the training and safety course are found in Section 027 of the regulations. Members of the active or reserve armed forces or members of the National Guard may meet this requirement with documentation that they have completed handgun

training within the previous three (3) years which meets the minimum safety and training requirements for the Handgun Training and Safety Course approved by the Nebraska State Patrol. An applicant for a permit who is certiied as an instructor for the Handgun

Training and Safety Course and who has actually taught the course may sign his or her own certiicate of completion of training without attending a class taught by another instructor

qProof of vision as evidenced on a current Nebraska motor vehicle operator’s license or a

current statement by a Nebraska licensed ophthalmologist or optometrist certifying that the applicant has been tested and meets the vision requirements prescribed for a Class “O” operator’s license - the standard for automobiles ( Nebraska Revised Statutes § 60-4,118).

qProof of identiication may include current Nebraska motor vehicle operator’s license, a Nebraska identiication card issued by the Nebraska Department of Motor Vehicles, or a current military identiication card

qProof of citizenship can be a birth certiicate showing birth in the United States, a copy of naturalization papers, a Certiicate of Citizenship issued by the United States Immigration authorities, or a United States passport.

qProof of address

qA signature

qThe applicable fee

At the time of the application submittal, the applicant will be ingerprinted. The concealed handgun

permit will bear permit holder’s photograph and signature. During the initial visit to the Nebraska

State Patrol Troop Area Headquarters, a photograph will be taken and signature will be captured

for adherence to the permit upon issuance.

An applicant must meet and maintain the following requirements:

•Be at least twenty-one (21) years of age

•Not be prohibited from purchasing or possessing a handgun by 18 U.S.C. 922 as that section existed on January 1, 2005

•Have had no convictions in any court of a crime punishable by imprisonment for more than one year (generally felony offenses)

•Not currently a fugitive from justice

•Not an unlawful user or addicted to a controlled substance under 21 U.S.C. 802 Section 102

(this does not require a conviction)

NSP1710 (01-07)

•Have not been adjudicated as a mental defective or commitment to a mental institution – this includes a inding of Not Guilty By Reason of Insanity or incompetent to stand trial in a criminal proceeding but does not include a temporary Emergency Protective Custody (EPC). (Note that there are no time limits on this section)

•Have not been discharge from the armed forces under dishonorable conditions – a dishonorable discharge, or the “dismissal” of an oficer from the armed forces adjudged by a general court-martial. Both are punitive and are considered to be under dishonorable conditions by federal authorities

•Have not renounced United States citizenship

•Not subject of a court order prohibiting contact with intimate partner or child of partner if the

order was issued after a hearing with actual notice and opportunity to participate and if the order includes a inding that the person represents a credible threat and explicitly prohibits the use of physical force against the intimate partner or child

•Have had no convictions in any court of a misdemeanor crime of domestic violence

•Must possess the eyesight necessary for a Class “O” operator’s license - the standard for automobiles

•Not have plead guilty or no contender or been convicted of a felony or crime of violence in any jurisdiction

•Not currently been adjudged mentally incompetent or have been found to be mentally ill and dangerous in the past ten (10) years. Emergency protective custody (EPC) does not disqualify an applicant unless it is followed by formal proceedings or treatment

•Current resident of the State of Nebraska having been a resident for at least the past one hundred eighty (180) days

•Have had no violations of any law relating to irearms, unlawful use of a weapon, or controlled substances in Nebraska or any other jurisdiction in the past ten (10) years. (Violations which disqualify include felonies, misdemeanors, infractions and violations of city ordinances)

•Not be on parole, probation, house arrest, or work release for any type of offense of any degree. This disqualiication does not include pre-trial diversion unless it is from a jurisdiction which requires the offender to enter a guilty plea before diversion

•Be a citizen of the United States

•Have successfully completed an approved training program

Issuance of Permit

If the application for a permit to carry a concealed handgun is complete and all accompanying documentation is submitted, a permit will be issued to the applicant by the Nebraska State Patrol within ive (5) business days after the completion of the criminal history record check, so long as

the record check reveals no disqualifying information and applicant meets all of the requirements of the Act and the regulations.

A permit holder may request to pick up the replacement permit in person or it shall be mailed to the address provided on the permit application.

NSP1710 (01-07)

Permit Renewal Information

The fee for a renewal permit is $50.00. The fee shall be paid with the application and shall be

paid in cash or check made payable to the Nebraska State Patrol. When it becomes feasible, payment may also be made with debit or credit cards approved by the Nebraska State Patrol.

Permit holders wishing to renew a permit to carry a concealed handgun may do so any time within the four (4) months prior to expiration of the initial permit at any Nebraska State Patrol Troop Headquarters or ofice provided by the patrol for purposes of accepting such applications.

An application for renewal must be completed by permit holder afirming that the permit holder

still meets all current requirements for obtaining a permit. The application must be accompanied with the appropriate fee. The permit will be renewed and reissued within ive (5) business days of receipt of the application valid for a ive year period from the date of expiration of the initial permit.

A current photograph will be required with the renewal application.

A permit holder letting an initial permit expire without applying for a renewal will be required to

apply for another initial permit and meet all of the requirements for an initial permit.

Lost/Stolen or Damaged Permit Replacement

A permit holder whose permit is lost, stolen, or damaged shall notify the Nebraska State Patrol in writing within ten (10) days of determining that the permit is lost, stolen, or damaged. When notiied of a lost, stolen, or damaged permit, the Nebraska State Patrol shall cancel the permit. The permit

holder shall not carry a concealed weapon until the Nebraska State Patrol issues a replacement.

A permit holder may obtain a replacement permit by submitting a written request for a replacement.

The replacement request shall require a statement about the facts and circumstances surrounding the “lost, stolen or damaged” permit. If the applicant still meets the requirements for a permit, the Nebraska State Patrol shall issue a replacement permit within ive (5) working days of receiving the request. The replacement permit shall have the same expiration date as the initial or renewed permit.

A permit holder whose permit is damaged may return the damaged permit to the Nebraska

State Patrol Concealed Handgun Permit Program with the permit holder’s written request for a

replacement permit.

The Concealed Handgun Permit Application provides the method for applying for a replacement

card by indicating that the applicant is making such application in the upper right hand corner of

the application. A space is being provided directly above the signature for applicant to provide statement about the facts and circumstances surrounding the “lost, stolen or damaged” permit.

If a peace oficer seizes a permit as evidence of a violation for a criminal case or a revocation proceeding, the oficer shall notify the Nebraska State Patrol Concealed Handgun Permit Program

immediately so that the permit will not be replaced as lost or stolen upon application by the permit holder. A form for this purpose will be available on the Nebraska State Patrol web-site at http:// www.nsp.state.ne.us.

Change of Name or Address

Permit holders who change name or address are required to notify the Nebraska State Patrol

Concealed Handgun Permit Program in writing within thirty (30) days of the change in name or address.

NSP1710 (01-07)

A permit holder may obtain a replacement permit by returning the current permit to the Nebraska

State Patrol Concealed Handgun Permit Program and submitting a written request for a replacement permit. The Concealed Handgun Permit Application provides the method for applying

for a replacement card by indicating that the applicant is making such application in the upper

right hand corner of the application. A space is being provided directly above the signature for applicant to provide statement about the facts and circumstances surrounding the “lost, stolen or damaged” permit.

If the applicant still meets the requirements for a permit, the Nebraska State Patrol shall issue a replacement permit within ive (5) working days of receiving the request. The replacement permit shall have the same expiration date as the initial or renewed permit.

A permit holder may request to pick up the replacement permit in person or it shall be mailed to the address provided on the permit application.

A permit holder moving to another state shall return the permit to the Nebraska State Patrol

Concealed Handgun Permit Program for cancellation.

Obligations and Responsibilities While Carrying

At all times while carrying a concealed handgun, a permit holder shall carry the concealed handgun permit; and Nebraska driver’s license, Nebraska-issued state identiication card, or military identiication card and display it to any peace oficer or emergency service personnel upon

request.

Violation of this provision is a Class III misdemeanor for the irst offense and a Class I

misdemeanor for a second or subsequent offense.

A permit holder carrying a concealed handgun who is oficially contacted by any peace oficer or emergency services personnel must immediately inform the peace oficer or emergency service

personnel of the concealed handgun unless physically unable to do so.

A peace oficer or emergency service personnel making contact with the permit holder may

determine that securing the handgun is necessary for the safety of any person present. If requested, the permit holder must immediately surrender or secure the handgun for safekeeping as ordered by the peace oficer or emergency service personnel until a determination has been

made that there is no concern for safety and that the permit holder will not be detained for law

violations or medical treatment. If the permit holder is transported for treatment by emergency service personnel, the handgun is to be turned over to a peace oficer as soon as it is feasible to do so. The peace oficer will provide the permit holder with a receipt for the handgun which will include make, model, caliber, and serial number.

A permit holder shall not carry a concealed handgun while consuming alcohol or while there is any previously consumed alcohol or controlled substance as deined in Nebraska Revised Statutes

§28-401 of the statutes in his or her blood, urine, or breath unless the controlled substance was lawfully obtained and taken in therapeutically prescribed amounts.

A permit holder must continue to meet all of these requirements for issuance of a permit during the time he or she holds a permit.

NSP1710 (01-07)

A permit holder no longer meeting the requirements for a permit is required to return the permit to the Nebraska State Patrol for cancellation. A permit holder who fails to return the permit is subject

to the formal revocation process described in Section 012 of the regulations

If a permit holder dies or becomes disabled, relatives or other responsible parties are requested to return the permit to the Nebraska State Patrol for cancellation. Permits can not be transferred to another person. No fees will be refunded for permits which are cancelled or revoked.

Reporting Injuries and Damage Caused By Firearm of Permit Holder

Any injury to a person or damage to property resulting from the discharge of a handgun carried by a permit holder must be reported by the permit holder to the Nebraska State Patrol within ten (10) days of the incident. The form for making such a report will be available on the Nebraska State

Patrol website at http://www.nsp.state.ne.us/ and can be downloaded for use in complying with this requirement. The report will not be required for minor property damage of minimal signiicance

–see the deinitions of property damage found in Section 002.11 of the regulations. A report is required for malicious damage inlicted with a handgun.

Denials

If applicant does not meet the qualiications, the applicant will be notiied by mail by the Nebraska

State Patrol indicating the reason for denying issuance of the permit.

Nebraska State Patrol will wait a period of ten (10) days to allow time for applicant to resolve the disqualiication. Should the applicant not resolve the disqualiication, the permit application fee

will be refunded to the applicant less the current charge for the required state and federal criminal history record checks.

Rights of Persons Denied Concealed Handgun Permit

An individual denied a permit may petition for an administrative hearing under the Administrative Procedures Act.

Within ten (10) working days of receipt of the letter of denial, persons denied a permit by the Nebraska State Patrol may ile a request for an administrative due process hearing to review the decision to deny the permit. A request shall be considered timely iled if placed in the United States mail with suficient postage, properly addressed to the Nebraska State Patrol, Concealed Handgun Permit Program, PO Box 94907, Lincoln, Nebraska 68509 within fourteen (14) working

days of the mailing of the letter of denial to the applicant by the Nebraska State Patrol.

If a hearing is requested, it shall be held pursuant to the Nebraska Administrative Procedures Act

and the Nebraska State Patrol Rules and Regulations pertaining to administrative hearings (Title 272 - Chapter 1). The petitioner (applicant) must specify through pleadings or at a prehearing conference what aspect of the decision is being challenged.

The scope of the hearing shall include a review of the accuracy of the information used in making the decision to deny a permit. The State Patrol has the burden of going forward with evidence

to show why the permit application was denied. A decision shall be made by the Superintendent within ifteen (15) working days of the hearing.

NSP1710 (01-07)

Appeals from the Superintendent’s decision shall be iled in the District Court of either the county in which the applicant resides or the county in which the applicant applied for a permit in accordance with the procedures set forth in the Nebraska Administrative Procedures Act.

No hearing will be afforded those failing to successfully complete an approved training program. Any disagreement with the training program should be addressed with the director of the training

program. If there is reason to believe that the training program is not following the training guidelines or is misapplying the law, such allegations should be brought to the attention of the

Superintendent of the Nebraska State Patrol.

Concealed Handgun Permit Revocation

Any peace oficer having probable cause to believe that a permit holder is no longer in compliance

with any of the requirements for a permit found in Section 005 of the regulations shall bring an application for revocation of the permit to the County Attorney in the county in which the permit holder resides.

This action is to be prosecuted as a civil case by either the County Attorney or by the Attorney

General in the event the County Attorney refuses or is unable to pursue the prosecution. Persons prosecuted under this provision are subject to revocation of their permit, an administrative ine of up to one thousand dollars ($1,000) and the costs of prosecution.

Reapplication After Denial or Revocation

A new application for a permit to carry a concealed handgun will automatically be denied if

received from an individual who has previously been denied a permit or whose permit has been revoked, unless the disqualiication has been remedied. The individual has the burden to document that the disqualiication has been removed.

NSP1710 (01-07)