Michigan Form Ri 012 – Fill Out and Use This PDF

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CONCEALED PISTOL LICENSE GUIDE

The information within this guide is required to be provided to Concealed Pistol License applicants. The applicant must complete the Concealed Pistol License Application and return the unsigned form, a passport-quality photograph, and documentation of the required training to the county clerk’s office.

To view a complete copy of the Michigan Concealed Pistol License law, visit a local library or the Michigan State Police’s Web site at www.michigan.gov/msp. A complete copy of the firearms laws of this state shall be furnished upon filing an application.

I. Concealed Pistol License Requirements

A. State Requirements

Applicants for a Michigan Concealed Pistol License must:

1.Be at least 21 years of age.

2.Be a citizen of the United States or an immigrant alien lawfully admitted into the United States.

3.Be a resident of the State of Michigan for at least 6 months prior to application. An applicant is a state resident if one of the following applies:

The applicant possesses a valid, lawfully obtained Michigan driver’s license or state identification card

The applicant is lawfully registered to vote in Michigan

The applicant is on active duty status with the United States Armed Forces and stationed outside of Michigan, but Michigan is the home of record

The applicant is on active duty status with the United States Armed Forces and is permanently stationed in Michigan, but the home of record is another state

Note: The 6-month residency requirement may be waived by the concealed pistol licensing board for new residents licensed by another state.

4.Have successfully completed a pistol safety training course.

5.Not be subject to any of the following:

An order requiring involuntary hospitalization or alternative treatment

An order finding legal incapacitation

A finding of not guilty by reason of insanity

6.Not be subject to a conditional bond release prohibiting purchase or possession of a firearm.

7.Not be subject to a Personal Protection Order (PPO).

8.Not be prohibited from possessing, using, transporting, selling, purchasing, carrying, shipping, receiving, or distributing a firearm under MCL 750.224f.

9.Have never been convicted of a felony in Michigan or elsewhere.

10.Have no felony charge pending in Michigan or elsewhere.

11.Have not been dishonorably discharged from the United States Armed Forces.

12.Have not been convicted of one of the following misdemeanors in the 8 years immediately preceding the date of application:

Failing to stop when involved in a personal injury accident, MCL 257.617a

Operating while intoxicated, second offense, MCL 257.625(9)(b)

Drunk driving, commercial vehicle, MCL 257.625m(4)

Reckless driving, MCL 257.626

Driving while license suspended or revoked, second or subsequent offense, MCL 257.904

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Operating aircraft while under the influence of intoxicating liquor or a controlled substance with prior conviction, MCL 259.185

Hindering or obstructing certain persons performing official weights and measures duties, MCL 290.629

Hindering, obstructing, assaulting, or committing bodily injury upon director or authorized representative, MCL 290.650

Operating an ORV under the influence of intoxicating liquor or a controlled substance, second or subsequent offense, MCL 324.81134(5)-(6)

Operating a snowmobile under the influence of intoxicating liquor or a controlled substance, second or subsequent offense, MCL 324.82127 punishable under section MCL 324.82128(1)(b) or (c)

Operating a vessel under the influence of intoxicating liquor or a controlled substance, second or subsequent offense, MCL 324.80176 punishable under MCL 324.80177(1)(b)

Possessing a controlled substance, controlled substance analogue, or prescription form, MCL 333.7403

Operating a locomotive under the influence of intoxicating liquor or a controlled substance, or while visibly impaired, MCL 462.353(4)

Displaying sexually explicit matter to minors, MCL 722.677

Assault or domestic assault, MCL 750.81

Aggravated assault or aggravated domestic assault, MCL 750.81a

Breaking and entering or entering without breaking, MCL 750.115

Fourth-degree child abuse, MCL 750.136b

Accosting, enticing, or soliciting a child for immoral purposes, MCL 750.145a

Vulnerable adult abuse, MCL 750.145n

Solicitation to commit a felony, MCL 750.157b

Impersonating a peace officer or medical examiner, MCL 750.215

Illegal sale of a firearm or ammunition, MCL 750.223

Illegal use or sale of a self-defense spray, MCL 750.224d

Sale or possession of a switchblade, MCL 750.226a

Improper transportation of a loaded firearm, MCL 750.227c

Failure to have a pistol inspected, MCL 750.228

Accepting a pistol in pawn, MCL 750.229

Failure to register the purchase of a firearm or a firearm component, MCL 750.232

Improperly obtaining a pistol, making a false statement on an application to purchase a pistol, or using false identification to purchase a pistol, MCL 750.232a

Intentionally aiming a firearm without malice, MCL 750.233

Intentionally discharging a firearm aimed without malice, MCL 750.234

Possessing a firearm on prohibited premises, MCL 750.234d

Brandishing a firearm in public, MCL 750.234e

Possession of a firearm by an individual less than 18 years of age, MCL 750.234f

Intentionally discharging a firearm aimed without malice causing injury, MCL 750.235

Parent of a minor who possessed a firearm in a weapon-free school zone, MCL 750.235a

Setting a spring gun or other device, MCL 750.236

Possessing a firearm while under the influence of intoxicating liquor or a drug, MCL 750.237

Weapon-free school zone violation, MCL 750.237a

Indecent exposure, MCL 750.335a

Stalking, MCL 750.411h

Fourth-degree criminal sexual conduct, MCL 750.520e

Reckless, careless, or negligent use of a firearm resulting in injury or death, MCL 752.861

Careless, reckless, or negligent use of a firearm resulting in property damage, MCL 752.862

Reckless discharge of a firearm, MCL 752.863a

Note: The applicant must not have violated a law of the United States, another state, or a local unit of government of this state or another state substantially corresponding to a violation described above.

13. Have not been convicted of one of the following misdemeanors in the 3 years immediately preceding the date of application:

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Operating under the influence, MCL 257.625 (includes operating while intoxicated or visibly impaired.)

Refusal of commercial vehicle operator to submit to a chemical test, MCL 257.625a

Ignition interlock device reporting violation, MCL 257.625k

Circumventing an ignition interlocking device, MCL 257.625l

Operating a commercial vehicle with alcohol content, MCL 257.625m(3)

Operating an aircraft under the influence, MCL 259.185

Operating an ORV under the influence, MCL 324.81134

Operating an ORV while visibly impaired, MCL 324.81135

Operating a snowmobile under the influence, MCL 324.82127

Controlled substances, MCL 333.7401 to 333.7461

Operating a locomotive under the influence, MCL 462.353(3)

Disorderly person, MCL 750.167

Embezzlement, MCL 750.174

False pretenses with intent to defraud, MCL 750.218

Larceny, MCL 750.356

Second-degree retail fraud, MCL 750.356d

Larceny, vacant building, MCL 750.359

Larceny, by conversion, MCL 750.362

Larceny, defrauding lessor, MCL 750.362a

Malicious destruction of property, MCL 750.377a

Malicious destruction of real property, MCL 750.380

Receiving stolen property, MCL 750.535

Malicious use of telephones, MCL 750.540e

Note: The applicant must not have violated a law of the United States, another state, or a local unit of government of this state or another state substantially corresponding to a violation described above.

14.Have not been found guilty but mentally ill of any crime and has not offered a plea of not guilty of, or been acquitted of, any crime by reason of insanity.

15.Have never been subject to an order of involuntary commitment in an inpatient or outpatient setting due to a mental illness.

16.Not have a diagnosed mental illness at the time the application is made, regardless of whether he or she is receiving treatment.

17.Not be under a court order of legal incapacity in this state or elsewhere.

18.Not be detrimental to the safety of his or her self or any other person if issued a Concealed Pistol License.

B. Federal Requirements

Pursuant to MCL 28.426, a Concealed Pistol License may not be issued to a person prohibited under federal law from possessing or transporting a firearm. The federal requirements to possess or transport a firearm include that the applicant:

1.Not have been convicted in any court of, or under indictment for, a crime punishable by imprisonment for a term exceeding one year (e.g. felony or misdemeanor punishable by 2 years).

2.Not be a fugitive of justice.

3.Not be an unlawful user of, or addicted to, any controlled substance, as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802).

4.Not be adjudicated as a mental defective or who has been committed to a mental institution.

5.Not be an alien who is illegally or unlawfully in the United States

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6.Not be discharged from the United States Armed Forces under dishonorable conditions.

7.Not have renounced his or her citizenship.

8.Not be subject to a court order prohibiting harassing, stalking, or threatening an intimate partner or child of such intimate partner or from engaging in other conduct that would place the partner or child in reasonable fear of bodily injury.

9.Not be convicted in any court of a misdemeanor crime of domestic violence.

II. Application Process

The applicant must file his or her application with the county clerk in the county in which he or she resides.

1.The applicant must also:

Present the original certificate of completion of the pistol safety training course. The county clerk will make a copy of the certificate at the time the application is submitted. Certificates must contain the statement: “This course complies with section 5j of 1927 PA 372.”

For a renewal of a license issued after July 1, 2001, the applicant must sign a statement certifying that he or she has completed at least 3 hours of review of the required training and has had at least 1 hour of firing range time in the last 6 months preceding the application. This statement appears on the Concealed Pistol License Application.

Include a passport-quality photograph.*

Pay all applicable fees. For all applications there is a $105 fee payable to the county clerk. The county clerk will provide a receipt for payment of fees.

2.The applicant shall bring the receipt for payment to the sheriff’s department for fingerprinting. An applicant may have his or her fingerprints taken at a local police agency; however, an additional charge may be assessed by the local agency. If the sheriff’s department participates with a vendor for fingerprinting, the county clerk will provide additional instructions.

3.The county sheriff or local law enforcement agency will fingerprint the applicant and forward the fingerprints to the Michigan State Police for processing.

4.Once the concealed weapon licensing board receives the fingerprint comparison report, they shall issue or deny the license within 45 days. Please note, however, that the entire application process may take several months.

5.The county clerk may require that all licenses be signed in their presence prior to receiving the license.

III. Pistol Safety Training Course

1.Those required to take a pistol safety training course include:

All new applicants.

Persons who had a Concealed Pistol License, general or restricted, prior to July 1, 2001, and are renewing for the first time.

2.The educational requirements are waived for an applicant who is a retired police officer or a retired law enforcement officer. The concealed weapon licensing board may require a letter from the employer that the applicant retired from his or her employment in good standing as a police officer or law enforcement officer. The terms “retired police officer” or “law enforcement officer” mean an individual who was a certified police officer or certified law enforcement officer as those terms are defined under section 2(k) of the commission on the Law Enforcement Standards Act, Public Act 203 of 1965, MCL 28.602, and retired in good standing from his or her employment as a police officer or law enforcement officer.

*Passport Photo Standards: The photo must be taken alone, sufficiently recent to be a good likeness (normally taken within the last 6 months), with an image size from bottom of chin to top of head (including hair) of between 1 and 1 3/8 inches. The photo must be clear, front view, full face, taken in normal street attire without a hat or dark glasses with a white or off-white background. The photo must be capable of withstanding a mounting temperature of 225 Fahrenheit (107 Celsius). Snapshots, most vending machine prints, and magazine, or full-length photographs are unacceptable.

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3.The training required under Michigan law must be a program certified by this state or a national or state firearms training organization and provides instruction in at least all of the following:

The safe storage, use, and handling of a pistol

Ammunition knowledge and the fundamentals of pistol shooting

Pistol shooting positions

Firearms and the law, including civil liability issues and the use of deadly force (this portion must be taught by an attorney or a person trained in the use of deadly force)

Avoiding criminal attack and controlling a violent confrontation

All laws that apply to carrying a concealed pistol in this state

At least 5 hours of instruction and 3 hours of range time that requires firing at least 30 rounds of ammunition

4.The instructor must be certified by this state or a national organization. The instructor must provide a signed certificate of completion to the applicant, stating that the individual successfully completed the course, and must contain the printed name and signature of the instructor. The certificate shall contain the statement: “This course complies with section 5j of 1927 PA 372.”

5.The following organizations offer certified pistol safety training courses:

Michigan Commission on Law Enforcement Standards (MCOLES) O www.mcoles.org or (517) 322-6525

National Rifle Association (NRA)

O www.nrahq.org/safety/education or (703) 267-1430

Michigan Coalition for Responsible Gun Owners (MCRGO) O www.mcrgo.org or (517) 484-2746

Note: This is not an all-inclusive list of certified instructors or facilities. An applicant may wish to contact his or her concealed weapon licensing board to inquire about other certified instructors or sites.

6.The concealed weapon licensing board may wish to confirm the validity of a certificate of completion by confirming the instructor’s certification with the organization that provided certification.

7.A person who either grants a certificate of completion to an individual knowing the individual did not satisfactorily complete the course or presents a certificate of completion to a gun board knowing the individual did not satisfactorily complete the course is guilty of a felony punishable by 4 years in prison and/or a $2,500 fine.

IV. Concealed Pistol License Renewal Information

1.A license to carry a concealed pistol is valid until the applicant’s date of birth that falls not less than 4 years or more than 5 years after the license is issued.

2.The concealed weapon license board shall issue or deny issuance of a renewal license within 60 days after the application for renewal is properly submitted. The county clerk shall issue the applicant a receipt for his or her renewal application at the time the application is submitted. The receipt shall contain all of the following:

Name of the applicant

Date and time the receipt is issued

The amount paid

A statement that the receipt is for a license renewal

A statement of whether the applicant qualifies for an extension under No. 4 below

The name of the county in which the receipt is issued

An impression of the county seal

3.If the concealed weapon licensing board fails to deny or issue a renewal license to the person within 60 days of the date of application, the expiration date of the current license is extended by 180 days or until the renewal license is issued, whichever occurs first. The extension does not apply unless the person pays the renewal fee at the time the renewal application is submitted, and the person has submitted a receipt from a police agency that confirms that the background check has been requested by the applicant.

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4.A person carrying a concealed pistol after the expiration date of his or her license pursuant to an extension under No. 3 above shall keep the receipt issued by the county clerk and his or her expired license in his or her possession at all times that he or she is carrying the pistol. For the purposes of Michigan law, the receipt is considered to be part of the license to carry a concealed pistol until a renewal license is issued or denied. Failing to have the receipt and expired license in possession while carrying a concealed pistol or failing to display the receipt to a peace officer upon request is a violation of Michigan law.

5.An application is considered a renewal if the applicant has received a Concealed Pistol License in compliance with the training requirements set forth in Michigan law after July 1, 2001. A Concealed Pistol License is renewed in the same manner as the original license, which may include fingerprints. For more information about the application process, refer to the Application Process section within this document.

6.An applicant applying for a renewal is not required to have fingerprints taken again if the applicant’s fingerprints have been submitted to and are maintained by the Michigan State Police. Fingerprints have been maintained by the Michigan State Police since January 1, 2006. If fingerprints were submitted prior to this date, the applicant applying for a renewal does not qualify for this exemption. For renewal applicants that do qualify, the county clerk will provide further instructions.

7.For an individual licensed after July 1, 2001, and subsequently applying for a renewal, completion of a pistol safety training course is not required. However, the applicant shall sign the statement on the application certifying that he or she has completed at least 3 hours of review of the pistol safety training course and has had at least 1 hour of firing range time in the 6 months immediately preceding the renewal application.

Exception: The training requirements are waived for an individual who is a retired police officer or retired law enforcement officer. The concealed weapon licensing board may require a letter that states the officer retired in good standing.

8.If there is a lapse between the previous license and the issuance of a new license, the individual has no right to carry a concealed pistol during that time lapse, other than the extension described in No. 3 above.

9.An individual licensed to carry a concealed pistol may carry the concealed pistol under that license until the license expires or the individual’s authority to carry the concealed pistol is otherwise terminated, whichever comes first.

V. Concealed Weapon Licensing Board

1.Each county shall have a gun board consisting of the sheriff or his or her designee, the director of the Michigan State Police or his or her designee, and the prosecuting attorney or his or her designee. The prosecutor may opt out, and the county board of commissioners will appoint a replacement. The replacement must be a certified firearm instructor. Certification must be by a state or national firearms program.

2.The board shall either issue or deny the license within 45 days after the board receives the fingerprint comparison report.

3.The board shall not issue a license if they determine that issuing the license would be detrimental to the safety of the applicant or any other individual. This determination shall be based on clear and convincing evidence of civil infractions, crimes, personal protection orders or injunctions, police reports or other evidence, or the applicant’s statements that bear directly on the applicant’s ability to carry a concealed pistol.

VI. Temporary Licenses

There are three instances where a concealed weapon licensing board may issue a temporary license:

1.If the board determines that there is probable cause to believe the safety of the applicant or a member of their family is endangered by the inability to immediately obtain a license to carry a pistol, a temporary license may be issued, valid for up to 180 days. This temporary license may be renewed for one additional 180-day period. For new residents, the concealed weapon licensing board may waive the 6-month residency requirement.

2.If the fingerprint report is not received by the board within 60 days from the time the Michigan State Police received the report from the FBI, the board shall issue a temporary license if the applicant is otherwise qualified for a license. The license is valid for 180 days or until the report is received, and a license is either issued or denied. Upon issuance or denial of the license to carry a concealed pistol, the applicant shall immediately surrender the temporary license to the concealed weapon licensing board that issued the temporary license.

3.If a person moves into Michigan from another state and has had a license in their previous state, the licensing board may waive the 6-month residency requirement.

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VII. Denials

1.If the concealed weapon licensing board denies issuance of a license, the board must inform the applicant within 5 business days, in writing, the reasons for the denial, along with a statement of the specific facts and copies of documentary evidence upon which the denial is based. The applicant must also be informed of his or her right to appeal the denial to the Circuit Court in the judicial circuit in which he or she resides.

VIII. Appeals

1.If the concealed weapon licensing board denies issuance of a license to carry a concealed pistol, or fails to issue that license as provided for in Michigan law, the applicant may appeal the denial or the failure to issue the license to the Circuit Court in the judicial circuit in which he or she resides. The appeal of the denial or failure to issue a license shall be determined by a review of the record for error. There may be a hearing if the decision of the concealed weapon license board was based on the grounds that issuing a license to the applicant is detrimental to the safety of the applicant or to any other individual. Witnesses in the hearing shall be sworn. A jury shall not be provided.

2.If the Circuit Court determines that the denial or failure to issue a license was clearly erroneous, the court shall order the concealed weapon licensing board to issue a license as required by Michigan law.

3.If the court determines that the decision of the concealed weapon licensing board to deny issuance of a license to an applicant was arbitrary and capricious, the court shall order the state to pay 1/3 and the county in which the concealed weapon licensing board is located to pay 2/3 of the actual costs and actual attorney fees of the applicant in appealing the denial.

4.If the court determines that an applicant’s appeal was frivolous, the court shall order the applicant to pay the actual costs and actual attorney fees of the concealed weapon licensing board in responding to the appeal.

IX. Purchasing a Pistol

1.A person who is issued a Concealed Pistol License after July 1, 2001, is not required to obtain a License to Purchase (RI- 10) prior to purchasing a pistol.

2.If the purchaser has a Concealed Pistol License in lieu of a License to Purchase (RI-10) permit, the purchaser must complete a Pistol Sales Record (RI-60). This form is available at local police or sheriff departments or from the Michigan State Police’s Web site at www.michigan.gov/msp. The seller keeps one copy of the form, the purchaser keeps one copy, and the remaining two copies are returned by the purchaser to their local law enforcement agency within 10 days. The law enforcement agency will forward one copy to: Michigan State Police, Firearms Records Unit, P.O. Box 30634., Lansing, Michigan 48933.

X. Responsibilities While Carrying

1.A concealed pistol licensee carrying a concealed pistol must:

Have his or her Concealed Pistol License in possession at all times.

Immediately disclose to a peace officer, if stopped, that he or she is carrying a concealed pistol.

Display his or her Concealed Pistol License to a peace officer upon request.

Display his or her driver license or Michigan personal identification card upon request.

Not carry a concealed pistol while under the influence of alcohol or a controlled substance or while having an unlawful bodily alcohol content. However, a licensee who has consumed alcohol can legally transport a pistol if the pistol is in a locked trunk or locked compartment or container that is separated from the ammunition for that pistol.

The licensee must have the Pistol Sales Record (RI-60) in his or her possession for the first 30 days after purchasing the pistol.

For more information on encounters with police, refer to the Michigan State Police’s Web site at www.michigan.gov/msp.

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XI. Pistol-Free Zones

1.All Concealed Pistol Licenses issued after July 1, 2001, are unrestricted. However, licensees are prohibited from carrying a pistol in the following places:

A school or school property. However, a parent or legal guardian of a student of the school is not precluded from carrying a concealed pistol while in a vehicle on school property while dropping off or picking up a student.

A private or public child care center or day care center, child caring institution, or child placing agency.

A sports arena or stadium.

A tavern or bar where the primary source of income is the sale of alcoholic liquor by the glass consumed on the premises.

Any property or facility owned or operated by a church, synagogue, mosque, temple or other place of worship, unless the presiding officials permit the carrying on the property.

An entertainment facility, with a seating capacity of 2,500 or more individuals, that the individual knows or should know has a seating capacity of 2,500 or more or that has a sign above each public entrance stating that the seating is 2,500 or more.

A hospital.

A dorm or classroom of a college or university.

Note: Parking areas of the above places are not pistol-free zones.

Note: A pistol also cannot be carried in violation of a rule promulgated pursuant to the Gaming Control and Revenue Act.

2.Pistol-free zones DO NOT apply to any of the following:

A licensee who is a retired police officer or retired law enforcement officer. The concealed weapon licensing board may require a letter from the law enforcement agency stating that the retired police officer or law enforcement officer retired in good standing.

An individual who is licensed as a private investigator or private detective under the Professional Investigator Licensure Act, Public Act 285 of 1965, MCL 338.821 to 338.851.

A licensee who is a corrections officer of a county sheriff’s department.

A licensee who is a Motor Carrier officer or Capitol Security officer of the Michigan State Police

A licensee who is a member of a sheriff’s posse.

A licensee who is an auxiliary officer or reserve officer of a police or sheriff’s department.

A licensee who is a parole or probation officer of the Department of Corrections.

A licensee who is a state court judge or retired judge. A concealed weapons licensing board may require a state court retired judge to obtain and carry a letter from the Judicial Tenure Commission stating that the judge retired in good standing.

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CONCEALED PISTOL LICENSE APPLICATION

I. General Information: Type or clearly print answers to all fields.

1. Full Legal Name (First, Middle, Last, Suffix)

2. Date of Birth

3. Previous Names or Alias (If applicable)

4. Daytime Telephone Number

5. Social Security Number (Voluntary)

6. Driver License Number or State Identification Number

7. a. Residential Address

b. Residential City

c. Residential Zip

8. a. Mailing Address (If different)

b. Mailing City

c. Mailing Zip

9. a. Race

b. Gender

c. Height

d. Weight

e. Hair Color

f. Eye Color

10. Name of Police Department in the City,

Village, or Township of

Residence (If applicable)

11. County of Residence

12. Are you a U.S. citizen?

13. a. Are you a Legal Immigrant Alien?

b. Indicate A or I-94 Number

c. Place of Birth

Yes

No

Yes

No

II. Type of License: Check the box next to the type of license that applies to this application.

New - Applying for a new license.

Temporary - If applying for a temporary license, attach a statement of facts supporting a temporary license.

Renewal - If renewing an existing license, complete the renewal information and certification below.

1. Renewal Information

a. Expiration Date

b. Issue Date

c. County of Issuance

d. Concealed Pistol License Number

2. Renewal Certification

I certify that I have completed at least 3 hours of review of the required training and have had a least 1 hour of firing range time in the last 6 months

preceding this application.

Signature

Date

III. Survey: Answer “yes” or “no” to the following questions.

1.		Have you ever been convicted of a felony in this state or elsewhere?					Yes	No
2.		Do you have a felony charge pending in this state or elsewhere?					Yes	No
3.		Have you been convicted of any misdemeanor listed on the Concealed Pistol License Guide in the 8 years preceding this application?					Yes	No
		If yes, please explain on the reverse side of this application.
4.		Have you ever been convicted of a misdemeanor crime of domestic violence?					Yes	No
5.		Do you have a personal protection order against you or been released by a judge or a district court magistrate subject to protective conditions?					Yes	No
6.		Have you ever been found guilty but mentally ill of any crime or offered a plea of not guilty of, or been acquitted of, any crime by reason of insanity?					Yes	No
7.		Have you ever been subject to an order of involuntary commitment in an inpatient or outpatient setting due to a mental illness?					Yes	No
8.		Do you have a diagnosed mental illness, regardless of whether you are receiving treatment for that illness?					Yes	No
9.		Are you under a court order of legal incapacity in this state or elsewhere?					Yes	No
10. Have you ever been dishonorably discharged from the United States Armed Forces?							Yes	No
11. Have you completed the training required for a new Concealed Pistol License (original documentation must be submitted with the application),							Yes	No
		OR have you certified above that you have completed the required review and firing range time for a renewal of your license?
12. Are you a retired police officer or retired law enforcement officer?							Yes	No
13. Are you exempt from pistol-free zones pursuant to MCL 28.425o? If yes, proof may be required to be presented to the concealed weapon licensing							Yes	No
	board. (See back for qualifying list.)
	IV. References: Provide the names, addresses, and telephone numbers of two references.
1.		Reference One
a. Name				b. Telephone Number
c. Residential Address				d. City		e. Zip
2.		Reference Two
a. Name				b. Telephone Number
c. Residential Address				d. City		e. Zip
	V. Agreement and Certification: Read the following statements. By signing below, you acknowledge they are true.
 I have read the information provided on carrying a concealed pistol and obtaining a Michigan Concealed Pistol License and I meet all of the criteria for a Concealed Pistol
		License under Public Act 372 of 1927, as amended.
 I give authority to the concealed weapon licensing board to access any record, including medical and mental health records, pertaining to my qualifications to receive a
		Concealed Pistol License. I understand I may request that the licensing board review my medical and mental health records in a closed session, and that I and my
		representative may be present at that closed session.
 I understand this application is executed under oath and swear or affirm under penalty of law that the above answers are true and correct to the best of my knowledge.
		I understand that intentionally making a false statement on this application is a felony punishable by imprisonment for not more than 4 years or a fine of
		not more than $2,500, or both.
 I have been provided with a copy of the compilation of the Firearms Laws of Michigan created by the Legislative Service Bureau.
Applicant’s Signature (Do not sign until instructed by the county clerk or his or her representative)						Date
Witness (County clerk or representative)						Date
		Return the completed unsigned form, a passport-quality photograph, and documentation of required training to the county clerk’s office.
		AUTHORITY: 1927 PA 372, as amended	COMPLIANCE: Voluntary PENALTY: Non-Issuance

RI-012 (10/2010)

MICHIGAN STATE POLICE

OFFICIAL USE ONLY (Optional)

This side to be completed by the concealed weapon licensing board/county clerk.

I.Background Clearance: Type or clearly print answers to all fields.

1. a. Name			b. License Number
2. a. Fingerprints Required	Yes	No	b. If no, date CPL Renew Status set to pending
3. a. Clearance Requested	Yes	No	b. Date

II.Pistol Free Zone Exemption: If claiming an exemption or exemptions, documentation may be requested supporting the claimed exemption(s). Check the box next to each exemption that applies.

Retired police or law enforcement officer.

The concealed weapon licensing board may require a letter from the law enforcement agency verifying that the retired police or law enforcement officer retired in good standing. Note: The exemption does not apply to current police or law enforcement officers.

Licensed private investigator or private detective under the Professional Investigator Licensure Act, 1965 PA 285, MCL 338.821 to 338.851.

Note: This does not apply to persons working for a private investigator. Corrections officer of a county sheriff’s department.

Note: This does not include state corrections officers.

Motor carrier officer or capitol security officer of the Michigan State Police.

Sheriff’s posse member.

Auxiliary or reserve officer of a police or sheriff’s department.

Parole or probation officer of the Michigan Department of Corrections. Note: This does not include all Michigan Department of Corrections officers. Current or retired state court judge.

In order to qualify, the concealed weapon licensing board may require a retired state court judge to obtain and carry a letter from the Michigan Judicial Tenure Commission stating that the retired state court judge is in good standing as authorized under the Constitution of the State of Michigan of 1963, Article VI, Section 30, and all rules promulgated under that section.

III.Board Action: Board members initial below.

Michigan State Police			Sheriff’s Office		Prosecutor or Alternate
	APPROVED	Issue Date		Expiration Date
	DENIED	Denial Date

Check all applicable reasons for denial below.

Under age 21

Did not meet U.S. citizen/immigrant alien/state resident requirement

Pistol safety training course not completed or not sufficient

Subject to mental health order

Subject to personal protection order (PPO)

Felony conviction(s)

Dishonorable discharge – U.S. military

Misdemeanor conviction(s)

Other mental health conviction(s)

Board decision – Detrimental to safety of the applicant or another person

Denial Comments