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Application For Concealed Handgun Permit SP-248 - Virginia

Application For Concealed Handgun Permit Form. This is a Virginia form and can be used in General Circuit Court Statewide .
 Fillable pdf Last Modified 8/31/2012
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SP-248 (7-1-2012) FILE NUMBER: ________________________________ APPLICATION FOR CONCEALED HANDGUN PERMIT COMMONWEALTH OF VIRGINIA VIRGINIA CODE § 18.2-308 RESIDENT PERMIT NONRESIDENT PERMIT RENEWAL SEE NOTICE 2 PAGE 3 1. FULL LEGAL NAME (ATTACH A S EP ARATE LISTING OF ANY ADDITIONAL NAMES YOU MAY HAVE US ED OR BEEN KNOWN BY) FIRST ___________________________ MIDDLE ______________________ LAST___________________________________ 2. DATE OF BIRTH MONTH (YOU MUST BE AT LEAS T 21 YEARS OF AGE) DAY _____ YEAR ________ ______ 3. RESIDENTIAL ADDRESS (ATTACH A S EP ARATE LISTING OF ALL ADDRES S ES WITHIN THE LAST 5 YEAR P ERIOD) STREET OR RURAL ROUTE ____________________________________ CITY ______________________________ COUNTY ____________________________ STATE _________ ZIP ____________ MAILING ADDRESS (IF DIFFERENT) ______________________________________________________________________EMAIL (OPTIONAL)_________________________________ 4. PHYSICAL FEATURES HEIGHT _____ WEIGHT ______ SEX _____ RACE _____ HAIR COLOR 5. SOCIAL SECURITY NUMBER (OPTIONAL) ________ EYE COLOR __________ SEE NOTICE 1 ON PAGE 3 SCARS, MARKS, TATTOOS, PECULIAR CHARACTERISTICS: ___________________________________________________________ 6. PLACE OF BIRTH COUNTRY OF CITIZENSHIP (YOU MUST BE A UNITED STATES UNITED STATES (LOCALITY/STATE/NATION) CITIZEN OR HAVE LAWFUL PERMANENT RES IDENCE. NON-CITIZEN AP P LICANTS MUST P ROVIDE A VALID INS -ISSUED ALIEN REGISTRATION NUMBER.) ALIEN REGISTRATION NUMBER:__________________________ 7. TELEPHONE NUMBER HOME___________________ OTHER __________________ _____________________________ OTHER: __________________________ 8. CHECK YES OR NO FOR EACH OF THE FOLLOWING QUESTIONS A. 1. HAVE YOU EVER BEEN CONVICTED OF A FELONY OFFENSE? (INCLUDE FELONY CONVICTIONS OF DRIVING UNDER THE INFLUENCE AND/OR ANY OFFENSE FOR WHICH YOU WERE CONVICTED AS A JUVENILE, WHICH WOULD HAVE BEEN A FELONY IF COMMITTED BY AN ADULT. IF YES, COMPLETE FORM 1 PART B PAGE 2. FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT. YES NO 2. HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OFFENSE WITHIN THE FIVE-YEAR PERIOD IMMEDIATELY PRECEDING THIS APPLICATION? (INCLUDE MISDEMEANOR CONVICTIONS OF DRIVING UNDER THE INFLUENCE. DO NOT INCLUDE TRAFFIC INFRACTIONS OR THOSE MISDEMEANORS SET FORTH IN TITLE 46.2 CODE OF VIRGINIA.) IF YES, COMPLETE FORM 1 PART B PAGE 2. FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALSE STATEMENT. B. YES NO HAVE YOU BEEN COMMITTED TO THE CUSTODY OF THE COMMISSIONER OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES? IF YES, COMPLETE FORM 2 PART A PAGE 2 ( SEE NOTICE 4 PAGE 3) HAVE YOU BEEN ACQUITTED BY REASON OF INSANITY, ADJUDICATED LEGALLY INCOMPETENT, MENTALLY INCAPACITATED OR ADJUDICATED AN INCAPACITATED PERSON BY A COURT OF VIRGINIA OR ANY OTHER COURT? IF YES, COMPLETE FORM 2 PART B PAGE 2. ( SEE NOTICE 4 PAGE 3) HAVE YOU BEEN INVOLUNTARILY ADMITTED TO A FACILITY OR ORDERED TO MANDATORY OUTPATIENT TREATMENT, OR WERE YOU THE SUBJECT OF A TEMPORARY DETENTION ORDER PURSUANT TO VA. CODE § 37.2-809 WHO LATER AGREED TO VOLUNTARY ADMISSION UNDER VA. CODE § 37.2-805? IF YES, COMPLETE FORM 2 PAGE 2 AS INDICATED BELOW. ( SEE NOTICE 4 PAGE 3) 1. COMPLETE PART C OF FORM 2 PAGE 2 IF INVOLUNTARILY ADMITTED 2. COMPLETE PART D OF FORM 2 PAGE 2 IF ORDERED TO MANDATORY OUTPATIENT TREATMENT 3. COMPLETE PART E OF FORM 2 PAGE 2 IF VOLUNTARILY ADMITTED SUBSEQUENT TO A TEMPORARY DETENTION ORDER HAVE YOU RECEIVED MENTAL HEALTH TREATMENT OR SUBSTANCE ABUSE TREATMENT IN A RESIDENTIAL SETTING WITHIN THE FIVE YEARS PRIOR TO THE DATE OF THIS APPLICATION? ARE YOU THE SUBJECT OF, OR NAMED AS A RESPONDENT IN A RESTRAINING ORDER OR A PROTECTIVE ORDER? AN ACTIVE RESTRAINING OR PROTECTIVE ORDER MAY BE AN AUTOMATIC DISQUALIFER IN VIRGINIA. SEE VA. CODE § 18.2-308.1:4. ARE YOU ADDICTED TO, OR AN UNLAWFUL USER OR DISTRIBUTOR OF MARIJUANA OR ANY CONTROLLED SUBSTANCE? ARE YOU AN ALIEN NOT LAWFULLY ADMITTED FOR PERMANENT RESIDENCE IN THE UNITED STATES? HAVE YOU BEEN DISCHARGED FROM THE ARMED FORCES OF THE UNITED STATES UNDER DISHONORABLE CONDITIONS? ARE YOU A FUGITIVE FROM JUSTICE? DO YOU HAVE ANY CRIMINAL CHARGE PENDING? IF YES, COMPLETE FORM 1 PART A PAGE 2. FAILURE TO ACKNOWLEDGE A P ENDING CHARGE MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT. YES YES YES NO NO NO C. D. E. YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO F. G. H. I. J. K. L. HAVE YOU, WITHIN THE THREE-YEAR PERIOD IMMEDIATELY PRECEDING THE DATE OF THIS APPLICATION, EITHER 1) BEEN FOUND GUILTY OF ANY DRUG-RELATED CRIMINAL OFFENSE AS SET FORTH IN ARTICLE 1 (§ 18.2-247 ET SEQ.) OF CHAPTER 7 OF TITLE 18.2 OR OF A CRIMINAL OFFENSE FOR THE ILLEGAL POSSESSION OR DISTRIBUTION OF MARIJUANA OR ANY CONTROLLED SUBSTANCE UNDER THE LAWS OF VIRGINIA, ANY OTHER STATE, THE DISTRICT OF COLUMBIA, OR THE UNITED STATES OR ITS TERRITORIES; OR 2) BEEN CHARGED WITH ANY OFFENSE ENUMERATED IN THIS PARAGRAPH AND THE TRIAL COURT FOUND THE FACTS OF THE CASE WERE SUFFICIENT FOR A FINDING OF GUILT AND DISPOSED OF THE CASE PURSUANT TO § 18.2-251 OR SUBSTANTIALITY SIMILAR LAW OF VIRGINIA, ANY OTHER STATE, THE DISTRICT OF COLUMBIA, OR THE UNITED STATES OR ITS TERRITORIES? IF YES, COMPLETE FORM 1 PART A OR B PAGE 2. DO YOU CURRENTLY HAVE A VALID RESIDENT CONCEALED HANDGUN PERMIT ISSUED BY A VIRGINIA CIRCUIT COURT? IF YES, NAME OF THE CIRCUIT COURT WHICH ISSUED THE PERMIT: ________________________________________ EXPIRATION DATE M. 9. ATTACH A PHOTOCOPY OF THE DOCUMENTATION THAT DEMONSTRATES YOUR COMPETENCE WITH A HANDGUN (INITIAL PERMITS ONLY). ______________ YES NO I, THE UNDERS IGNED, AFFIRM THAT THE INFORMATION CONTAINED IN THIS AP P LICATION AND IN ANY ATTACHMENTS TO THIS DOCUMENT IS BOTH CORRECT AND COMP LETE TO THE BES T OF MY KNOWLEDGE. THE WILLFUL MAKING OF A FALS E S TATEMENT IN THIS AP P LICATION CONS TITUTES P ERJ URY AND IS P UNIS HABLE IN ACCORDANCE WITH §18.2-434 OF THE CODE OF VIRGINIA. I ALS O AFFIRM AND UNDERS TAND THAT THE IS S UANCE OF A CONCEALED HANDGUN P ERMIT DOES NOT NECES S ARILY ENTITLE ME, THE UNDERS IGNED, TO P OS S ES S , TRANS P ORT OR S ELL A FIREARM UNDER S TATE OR FEDERAL LAW. / MONTH DAY / YEAR APPLICANT'S SIGNATURE STATE OF ________________, CITY COUNTY TO WIT: ACKNOWLEDGED, SUBSCRIBED AND SWORN TO BEFORE ME ON / MONTH DAY / YEAR NOTARY PUBLIC COURT CLERK: MY COMMISSION EXPIRES REGISTRATION # American LegalNet, Inc. www.FormsWorkFlow.com PART A PENDING CHARGES (FOR ADDITIONAL
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