Jefferson County Pistol Permit Form PDF Details

Applying for a pistol permit in Jefferson County, Alabama requires careful attention and detailed information as outlined by the Jefferson County Sheriff’s Office Pistol Permit Application. First, this comprehensive process underscores the importance of honesty and accuracy, warning applicants that providing false statements is a punishable offense. Applicants are required to undergo a criminal history background check, highlighting the system's robust measures for ensuring public safety. The form requests a wide range of personal information, from basic details like full name, age, and residence, to more specific queries about previous pistol permits, legal history, mental health, and substance abuse treatment. Notably, questions are designed to assess the applicant's eligibility and potential risks thoroughly—touching on past convictions, ongoing criminal cases, mental health statuses, and any legal restrictions that might impact one’s ability to responsibly own a pistol. Conditions of denial or revocation of the permit are clearly stated, emphasizing the strict criteria upheld by the state and the local law enforcement agency. The application process thus reflects a careful balance between an individual's rights and community safety concerns, ensuring that permits are issued to qualified, responsible individuals.

QuestionAnswer
Form NameJefferson County Pistol Permit Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesalabama permit form, jefferson county permit alabama, permit application for alabama, permit application

Form Preview Example

JEFFERSON COUNTY SHERIFF’S OFFICE

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:

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

 

Middle

Other Names You Have Been Known By:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County of residence:

 

 

 

 

 

 

 

 

 

 

 

Requesting permit for

years (may apply for up to five (5) years)

Physical Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Number

 

 

 

 

Apartment Number

Street Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

Zip Code

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

State

 

 

Zip Code

Email Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone Numbers:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cell

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you a U.S. Citizen?

Age:

 

 

 

 

Date of Birth:

 

/

 

/

 

Place of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

Yes No

Sex:

 

Male

 

 

 

Female Race:

 

 

Height:

Weight:

 

 

 

Hair Color:

Eye Color:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License Number:

 

 

 

 

 

 

 

 

 

 

 

 

Other State I.D.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

Number

 

 

 

 

 

 

 

 

 

 

State

Number

 

 

 

 

 

Social Security Number:

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you ever had a pistol permit?

If so, where and when?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you ever had a pistol permit revoked or denied? If so, where and when?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you ever been convicted of a crime?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Are you now or have you ever been under an indictment?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Are you now or have you ever been treated for a mental illness or substance abuse (drugs/alcohol)?

 

 

 

 

 

Yes

No

 

Are you now or have you ever been under a restraining order to prevent endangering yourself or others?

 

 

 

 

 

Yes

No

 

Are you awaiting trial as a defendant in any criminal case?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you been found guilty by reason of mental illness in a criminal case?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you been found not guilty in a criminal case by reasons of insanity or mental disease or defect?

 

 

 

 

 

Yes

No

 

Have you been declared incompetent to stand trial in a criminal case?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you asserted a defense in a criminal case of not guilty by reason of insanity or mental disease or defect?

Yes

No

 

Have you been found not guilty by reason of lack of mental responsibility under the Uniform Code of Military Justice?

Yes

No

 

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?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

Have you required involuntary commitment to a psychiatric hospital or similar treatment facility for any reasons, including drug use?

Yes

No

 

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 Alabama or the United States?

 

 

 

 

 

 

 

 

 

 

 

 

 

If you answered YES to any of the questions above, please use the space below to provide dates and places of arrests or treatment, charges, agency involved 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.

Applicant’s Signature:

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

DO NOT WRITE BELOW THIS LINE – FOR OFFICIAL USE ONLY

APPROVED:

 

 

 

 

 

 

 

FEE FOR PERMIT $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISAPPROVED:

 

 

 

 

 

 

AUTHORIZED SIGNATURE:

 

 

 

 

NCIC

 

 

ACJIC

 

 

 

NICS

 

TRANSACTION #

 

OTHER

 

06.18.2013

STATE OF ALABAMA

NOTICE OF DENIAL/REVOCATION

FOR PISTOL PERMIT

Today’s Date

Name

Address

CityStateZip Code

The above named individual submitted an application for a concealed pistol permit in

 

County, Alabama, on the

day of

, 20

.

The reason for denial of the pistol permit application or revocation of existing pistol permit is listed below.

Having contacted available local, state, and federal criminal history data banks, including the National Instant Criminal Background Check System, it is determined that the above named applicant is prohibited from possession of a pistol or firearm pursuant to State or Federal law.

There is a reasonable suspicion that the applicant/permit holder may use a weapon unlawfully.

There is a reasonable suspicion that the applicant/permit holder will endanger himself/herself.

There is a reasonable suspicion that the applicant/permit holder will endanger others.

The evidence upon which the denial/revocation is based is

Signature of Person Conducting Research

Sheriff’s Signature

Date

Attachments: Yes No

06.18.2013

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Criminal Background Check System, Name Address City The above named, and Having contacted available local in permit alabama

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