Fremont County Sheriff s Office

Transcription

1 Fremont County Sheriff s Office CONCEALED HANDGUN PERMIT APPLICATION CHECKLIST Application processing times: (excluding holidays) by Appointment ONLY. You MUST bring all the required documents and all the necessary paperwork FILLED OUT completely and ready to go for your appointment; otherwise, you may be asked to reschedule to a later date and time REQUIRED DOCUMENTS RENEWAL APPLICANTS The application completed but not signed. (this is the same as the original application, but says renewal, write your permit number and expiration date). All applicants must sign the application in the presence of sheriff s representative. NO PROOF OF TRAINING IS REQUIRED. ID information form (completed and signed). Valid Colorado Driver s License or State ID. Proof of Fremont County residency: if your current address is not reflected on the front of your Driver s License or ID, additional documentation will be required. ALL documents presented must be dated within 1 to 2 months of your application date. (see accepted forms of residency) CBI Fee: $13.00 (Cashier Check or Money Order ONLY), payable to CBI (cash and personal checks are not accepted) Sheriff s Fee: $50.00 (or $65.00 if renewing after permit expiration date) we accept Cash, Money Order, Cashier s Check and Personal Check with a Fremont County printed address) payable to the Fremont County Sheriff s Office. Current Concealed Handgun permit. Affidavit of renewal Name Change (If you had a name change within the last 5 years, we will have to submit a fingerprint card along with your application (no additional fees) to CBI for application verification. The application process will take approximately 15 minutes, at that time a new photograph will be taken. For questions, please contact CHP coordinator at Updated 10/29/18

2 COLORADO CONCEALED HANDGUN PERMIT APPLICATION WARNING: The information you provide will be verified. Providing false information on this application constitutes a criminal offense for which you may be prosecuted. Print or type all information. Do not sign application. Type of Permit - New - Renewal (permit# - Temporary Emergency (need proof of threat) applying for: issued by County) - Retired Peace Officer (retired within last 5 years) County of Issue: FREMONT Applicant s Full Name (Last, First, Middle): Resident of Colorado? - Y Colorado is primary residency - N Other Names (nicknames, maiden name, alias, etc.): **Colorado County of Residence: Colorado DL#: Colorado ID#: Military ID#: * Social Security Number: Date of Birth: Current Home Address: City / State / Zip: Home Phone: (contact me at this #) Mailing Address, if Different from Above: City / State / Zip: Cell Phone: (contact me at this #) Years at Current Address: If at current address less than 10 years, list previous addresses for the past 10 years: (attach separate sheet of paper if necessary) * Social Security number is voluntary, but may assist in the background investigation in the event there are other individuals with a similar name who have had contact with law enforcement. It also helps ensure your record will not be accidentally merged with that of any other individual. ** If not a resident of the county you are applying in, you must provide paperwork showing proof of property/business you own/lease in that county and attach a copy to this application. Applicant History If you answer yes to questions one through 14, provide a detailed explanation on a separate sheet and attach it to this form. Where applicable, the information provided must include dates, locations, etc. Reference your explanations by preceding each with the number of the pertinent question. Print or type all information. Attachment must be clearly legible. Concerning convictions - answer no if pardoned or if the conviction has been expunged, sealed or set aside. 1. Have you been treated for alcoholism within the past ten years or ever been involuntarily committed as an alcoholic?... -Y -N 2. Have you had two or more alcohol-related convictions within the past ten years?... -Y -N 3. Have you ever been convicted of perjury under C.R.S. Section ?... -Y -N 4. Are you currently the subject of either a criminal or civil restraining order?... -Y -N 5. Are you under indictment or information in any court for a felony, or any other crime, for which the judge could imprison you for more than one year?... -Y -N 6. Have you been convicted in any court of a felony, or attempt or conspiracy to commit a felony, or any other crime for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation?... -Y -N 7. Are you a fugitive from justice?... -Y -N 8. Are you an unlawful user of, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance? *Warning: The medicinal or recreational use of marijuana, although legalized in Colorado, is illegal pursuant to federal law and would prohibit the lawful possession of firearms pursuant to 18 USC922(g)(3)... -Y -N 9. Have you ever been adjudicated mentally defective (which includes having been adjudicated incompetent to manage your own affairs) or have you ever been committed to a mental institution?... -Y -N 10. Have you ever been convicted in any court of a misdemeanor crime of domestic violence as defined in the code of Federal Regulations, subpart ?... -Y -N 11. Have you ever been adjudicated as a juvenile for a crime that would constitute a felony if committed by an adult or attempt or conspiracy to commit a felony, under any State law or Federal law?... -Y -N 12. Have you ever been discharged from the Armed Forces under dishonorable conditions?... -Y -N 13. Have you ever renounced your United States citizenship?... -Y -N 14. Are you of alien or non-citizen status in the United States? (If you answer yes, please complete supplemental form)... -Y -N

3 PROOF OF TRAINING NEW APPLICANTS ONLY (Please check ONE pertaining to your NEW application submittal and provide a COPY with your application.) A training certificate from a handgun training class (as defined in C.R.S ) obtained within ten years preceding submittal of this application. Proof of honorable discharge from a branch of the United States Armed Forces (DD214) within three years preceding submittal of this application. Proof of honorable discharge from a branch of the United States Armed Forces (DD214) that reflects pistol qualifications obtained within ten years preceding submittal of this application. Evidence that, at the time of this application is submitted, the applicant is a certified instructor. Evidence of experience with a firearm through participation in organized shooting competitions, current military service or current law enforcement. A certificate showing retirement from a Colorado Law Enforcement Agency that reflects pistol qualifications obtained within ten years preceding submittal of this application. NOTICE OF DISCLAIMER AND PERSONAL INQUIRY WAIVER NOTE TO RECIPIENT: A photocopy reproduction of this signed request shall be for all intents and purposes as valid as the original. You may retain this form in your files. The original of this form will remain in the sheriff s office concealed handgun files. Handguns are classified by both Federal and Colorado law as deadly weapons. They are capable of causing death, serious injury, and property damage. I certify that I have read and understand the information provided in the application packet and the attached Colorado Revised Statutes pertaining to the uses of deadly physical force, and agree that any violation will be cause for revocation of this permit. By issuing this permit, the issuing County Sheriff, Sheriff s Office County, County Sheriffs of Colorado, and employees shall not be held liable or responsible for the manner in which the permit holder uses the concealed handgun or the results of said use, including, but not limited to, the death of, or injury to, any person or damage to any property resulting either directly or indirectly from the intentional, reckless, negligent or accidental discharge of a handgun, or any criminal acts committed by the permit holder involving the use of the concealed handgun. Furthermore, the issuing County Sheriff s Office in no way stands as Warrantor or Guarantor of the structural, mechanical, or functional fitness of a handgun for any purpose whatsoever. By signing this application, I acknowledge and accept the terms contained in the Notice of Disclaimer. I hereby certify that all statements made by me in the completion of this application are, to the best of my knowledge, accurate and true. I understand that any false answer (deceitfully made), or any fraud whatsoever, constitutes a basis for rejection of this application with no further consideration. If fraud and/or deceit is subsequently discovered, such fraud and/or deceit will become grounds for rejection of this application and may result in criminal charges. I fully understand that the issuing County Sheriff s Office conducts a background investigation of all applicants who are being considered for a concealed handgun permit. This investigation includes, but is not limited to, an investigation of military, police, driving records, and character. I hereby authorize any person who is contacted by the issuing County Sheriff s Office personnel to release any information to the issuing County Sheriff s Office pertaining to the background investigation including, but not limited to, military, police, driving records, and character for use by the issuing County Sheriff s Office in the consideration of my application. I further agree to release and hold harmless the issuing County Sheriff s Office, its agencies, elected officials, officers, agents, and employees from any and all liability or claims which I may have arising out of the disclosure of such information to the issuing County Sheriff s Office in the consideration of my application. This authorization for the release of information shall be valid for a six (6) month period from the date hereof. Any release of claims or liability set forth herein shall survive the termination of the agreement. The applicant swears under oath that the contents and information contained in this concealed handgun permit application is true and correct. Applicant s Signature (must sign in the presence of the Sheriff/Designee) Sheriff/Designee Subscribed and sworn before me this day of, 20 CHP/Revised 08-16

4 OFFICE OF SHERIFF, FREMONT COUNTY 100 JUSTICE CENTER ROAD Canon City, Colorado Phone (719) FAX (719) Conceal Handgun Permit ID Information Form Full legal name: Last Name First Name Middle Name Alias/Maiden/AKA: Citizenship (country): Soc. Sec. No: - - Sex: Race: Height: Weight: Eyes: Hair: ft. in. Green-GRN Hazel-HAZ Blue-BLU Brown-BRO Black- BLK Red/Auburn- RED Gray-GRY Blonde-BLN Bald-BLD Date of Birth: / / MM DD YYYY State Place of Birth: Home Address (No PO Box): City State Zip Code Employer Name: Occupation: Employer Address: City State Zip Code Signature: Date: Your signature acknowledges: You received a copy of the Privacy Act Notification and Notice to Applicants information provided by CBI (applies to applicants being fingerprinted). I understand that my fingerprints will be retained by the Colorado Bureau of Investigation and the Federal Bureau of Investigations. 5/18 FCSO RA

5 RENEWAL APPLICANTS ONLY CHP Renewal Affidavit I,, certify under perjury that I remain qualified to carry a conceal weapons permit, pursuant to the criteria specified in CRS (1a-1g): o I am a legal resident of the state of Colorado o Not ineligible to possess a firearm pursuant to CRS or federal law o Have not been convicted of perjury under CRS o Do not chronically and habitually use alcoholic beverages to the extent that my normal faculties are impaired o Have not had two or more alcohol related convictions under section CRS (1) or (2) within the ten-year period preceding the date the application is submitted o Not an unlawful user of or addicted to a controlled substance as defined in CRS (5) o Not subject to a permanent or temporary protection order Applicant s Signature ********************************************************************************** Subscribed and sworn before me this day of,. Witness my hand and official seal. Notary Public My commission expires:

6 Colorado Bureau of Investigation Privacy Act Notification Privacy Act Notification Authority: The FBI s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L , Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI s Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. [If other agencies are involved in processing this application, they may have additional routine uses; specifically, some state agencies may share potentially pertinent information, including criminal history information between and among other employing, investigating, or otherwise responsible agencies within that state.] RF3 CBI Revised 06/24/2014 CJIS Portion Revised 09/09/2013

7 Identification Unit 690 Kipling Street, Suite 3000 Denver, CO NOTICE TO APPLICANTS As an applicant for a position requiring fingerprints to be submitted to the Colorado Bureau of Investigation and the Federal Bureau of Investigation, YOUR FINGERPRINTS WILL BE SUBMITTED TO THESE AGENCIES TO CHECK STATE AND FBI RECORDS. Discrepancies on your Colorado record can be challenged and corrected by contacting the Colorado Bureau of Investigation at 690 Kipling St., Suite 3000, Denver, CO 80215, or by calling the Identification Unit at (303) Additional information is available from CBl's website at Discrepancies on records from the FBI or relating to another state can be challenged through the FBI. Information, including that listed below, can be found at their website at The U.S. Department of Justice Order establishes rules and regulations for the subject of an FBI Identification Record to obtain a copy of his or her own record for review. The FBl's Criminal Justice Information Services (CJlS) Division processes these requests. Who May Request a Copy of a Record (or Proof That a Record Does Not Exist) Only you can request a copy of your own Identification Record. How to Request a Copy of Your Record The FBI offers two methods for requesting your FBI Identification Record or proof that a record does not exist. Option 1: Submit your request directly to the FBI. Option 2: Submit to an FBI-a pproved Channeler, which is a private business that has contracted with the FBI to receive the fingerprint submission and relevant data, collect the associated fee(s), electronically forward the fingerprint submission with the necessary information to the FBICJIS Division for a national criminal history record check, and receive the electronic record check result for dissemination to the individual. Contact each Channeler for processing times. AGENCY INSTRUCTIONS: To comply with federal law, provide a copy of this document to each applicant fingerprinted. 700 Kipling Street Suite 1000, Lakewood, CO cdpsweb.state.co.us John W. Hickenlooper, Governor Stan Hilkey, Executive Director