Pistol Permit Application
Pistol Permit Application
Read the following questions carefully and make sure your answers are correct. It is a crime to make a false statement or report to law enforcement.
(TITLE 13A-10-109 ALABAMA CODE.)
All Fields Are Required
Name:
Last:
First:
Middle:
Other Name/Maiden:
Contact Information:
Physical Address:
Street:
City:
State:
Zip:
Home Telephone:
Mailing Address:
Street:
City:
State:
Zip:
Employer:
Emp. Name or Business Type
(if self-employed)
Address:
Work Telephone:
Email Address:
Personal Information:
Date Of Birth:
(ex. 12/13/1987)
Place of Birth:
Social Security Number:
Age:
Sex:
M
F
Race:
W
B
H
A
I
Other
Height:
(Ex. 511 or 503)
Weight:
lb
Eye Color:
Hair Color:
Are you a US Citizen:
DL State:
Driver License #:
Yes
No
1.
Have you ever had a pistol permit? If so, where and when?
(answer in space below)
2.
Have you ever had a pistol permit revoked or denied? If so, where and when?
(answer in space below)
3.
Have you ever been arrested for a crime of violence?
4.
Have you ever been taken into custody by a law enforcement agency?
5.
Have you ever been arrested or charged with a crime?
6.
Are you currently under an indictment?
7.
Have you ever been treated for a mental illness?
8.
Have you ever been treated for substance abuse (drugs/alcohol)?
9.
Are you addicted to alcohol, prescription medicine or illegal drugs?
10.
Are you on probation, parole, under a restraining order or protection from abuse order from ANY court?
11.
Are you awaiting trial as a defendant in any criminal case?
12.
Have you been found not guilty in a criminal case by reasons of insanity or mental disease or defect?
13.
Have you been declared incompetent to stand trial in a criminal case?
14.
Have you asserted a defense in a criminal case of not guilty by reason of insanity or mental disease or defect?
15.
Have you been found not guilty by reason of lack of mental responsibility under the Uniform Code of Military Justice?
16.
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?
17.
Have you required involuntary commitment to a psychiatric hospital or similar treatment facility for any reasons, including drug use?
18.
Have you been the subject of prosecution or 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 use the area below to provide the date of arrest or treatment, the charges, the department, the disposition of the case, where treated, etc.
(Maximum characters: 200; no special characters allowed)
You have
characters left.
I HEREBY APPLY FOR A LICENSE TO CARRY A REVOLVER OR PISTOL ON MY PERSON OR IN A VEHICLE. I CERTIFY THAT MY ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT A DELIBERATE FALSEHOOD COULD SUBJECT ME TO PENALTIES OF THE LAW.
Sign here by typing your full legal name:
Incomplete applications will not be processed
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