San Andreas Police Department - Firearm License CCW Format

[/i][/u]_
Applicant Signature
_dd/mm/yyyy_
Date[/ul]

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[/u][/b] Name:

02. City and County of Residence: City, County
03. Country of Citizenship:
04. Date of Birth: DD/MM/YYYY

05. [IF US] City, County, State of Birth:
05. [IF NON-US] City, Country of Birth :

06. Height: FT' IN"
07. Weight: lbs.
08. Eye Color:
09. Hair Color:
10. Sex: Male/Female
11. Race: White/Black/Hispanic/Asian/Other

12. Residence Address: Street Number and Street Name including Apartment
13. Contact Number: 1111111
14. Occupation: Job
15. Business/Employer Name: Employer/Business

16. Link to Accepted PF Application: ACCESS

[/ul]

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[/u][/b] Do you now have, or have you ever had a license to carry a concealed weapon (CCW)?
No___ Yes___ (If yes, please indicate below):

Issuing Agency_N/A_ Issue Date_N/A_

02. Have you ever applied for and been denied a license to carry a concealed weapon?
No___ Yes___ (If yes, please indicate below):

Agency_N/A_ Date_N/A_ Reason for Denial_N/A_

03.If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other than honorable?
No___ Yes___ (If yes, explain):

_N/A_

04. Are you now, or have you been a party to a lawsuit in the last five years?
No___ Yes___ (If yes, explain):

_N/A_

05. Are you now, or have you been, under a restraining order(s) from any court?
No___ Yes___ (If yes, explain):

_N/A_

06. Are you on probation or parole from any state for conviction of any offense including traffic?
No___ Yes___ (If yes, explain):

_N/A_

07. Have you ever been convicted for any criminal offense (civilian or military) in the U.S. or any other country?
No___ Yes___ (If yes, explain including date, agency, and charges):

_N/A_

08. Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity?
No___ Yes___ (If yes, explain):

_N/A_

09. Are you now, or have you ever been, addicted to a controlled substance or alcohol, or have you ever utilized an illegal controlled substance, or have you ever reported to a detoxification or drug treatment program?
No___ Yes___ (If yes, explain):

_N/A_

10. Have you ever been involved in an incident involving firearms?
No___ Yes___ (If yes, explain):

_N/A_

11. Have you been involved in a domestic violence incident?
No___ Yes___ (If yes, explain):

_N/A_

12. Have you withheld any fact that might affect the decision to approve this license?
No___ Yes___ (If yes, explain):

_N/A_
[/ul]

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[/u][/b] Make Model Caliber
2. Make Model Caliber
3. Make Model Caliber
[/ul]

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Pursuant to U.S. Government Code – Title 49, Chapter 26, Section 1472(1) and Federal Aviation Regulation 121.583, a license to carry a concealed weapon does not authorize a person to carry a firearm or any dangerous weapon aboard commercial airlines. Further, a person must declare that he/she is carrying such firearm or dangerous weapon BEFORE entering the boarding area of an air terminal where the security checks are made. Such violation can result in arrest by law enforcement.

Any violation of these restrictions or conditions may invalidate the CCW license and may void any further use of the license until reinstated by the licensing authority. Any arrest for a felony or serious misdemeanor, including driving under the influence of alcohol and/or drugs, is cause for invalidating the license.[/ul]

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[/i][/u]_
Applicant Signature
_dd/mm/yyyy_
Date[/ul]

---

[/u]

<Reasoning here>

[/ul]

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SECTION 7 - CERTIFICATION AND RELEASE OF INFORMATION

[/i][/u]_
Applicant Signature
_dd/mm/yyyy_
Date[/ul]

---

[/u][/b] Screenshot of Character Level: ACCESS[/ul]


[div align="center"][font size="3"][b]San Andreas Police Department[/b][/font]

[img src="http://i1143.photobucket.com/albums/n635/GeorgeForan/Los%20Santos%20Police%20Department/Office%20and%20Divisional%20Images/Personnel%20and%20Training%20Bureau/FLDsmall.png"]

[b][font size="3"]STANDARD APPLICATION[/font][/b]
[font size="3"][font style="font-weight:bold;"]for[/font]
[font style="font-weight:bold;"]LICENSE TO CARRY A CONCEALED WEAPON (CCW)[/font][/font][/div]
[hr][/div]

[div style="text-align:center;"][u style="font-size:10pt;"][b][font size="3"]PUBLIC DISCLOSURE ADMONITION[/font][/b][/u][/div]            
[ul]I understand that I am obligated to be complete and truthful in providing information on this application. I understand that all of the information disclosed by me in this application may be subject to public disclosure.
           
_[u][i]Firstname Lastname[/i][/u]_
[font size="2"]Applicant Signature[/font]
_[u]dd/mm/yyyy[/u]_
[font size="2"]Date[/font][/ul]

[hr]
[div style="text-align:center;"][u style="font-size:10pt;"][b][font size="3"]SECTION 1 - APPLICANT PERSONAL INFORMATION[/font][/b][/u][/div]
[ul][b][u]01.[/u][/b] Name:

[b][u]02.[/u][/b] City and County of Residence: City, County
[b][u]03.[/u][/b] Country of Citizenship:
[b][u]04.[/u][/b] Date of Birth: DD/MM/YYYY

[b][u]05.[/u][/b] [IF US] City, County, State of Birth:
[b][u]05.[/u][/b] [IF NON-US] City, Country of Birth :

[b][u]06.[/u][/b] Height: FT' IN"
[b][u]07.[/u][/b] Weight: lbs.
[b][u]08.[/u][/b] Eye Color:
[b][u]09.[/u][/b] Hair Color:
[b][u]10.[/u][/b] Sex: Male/Female
[b][u]11.[/u][/b] Race: White/Black/Hispanic/Asian/Other

[b][u]12.[/u][/b] Residence Address: Street Number and Street Name including Apartment
[b][u]13.[/u][/b] Contact Number: 1111111
[b][u]14.[/u][/b] Occupation: Job
[b][u]15.[/u][/b] Business/Employer Name: Employer/Business

[b][u]16.[/u][/b] Link to Accepted PF Application: [a href=""]ACCESS[/a]

[/ul]

[hr]
[div style="text-align:center;"][u][font size="3"][b]SECTION 2 - APPLICANT CLEARANCE QUESTIONS[/b][/font][/u][/div]
[ul][b][u]01.[/u][/b]  Do you now have, or have you ever had a license to carry a concealed weapon (CCW)?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, please indicate below):

Issuing Agency_[u]N/A[/u]_ Issue Date_[u]N/A[/u]_

[b][u]02.[/u][/b] Have you ever applied for and been denied a license to carry a concealed weapon?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, please indicate below):

Agency_[u]N/A[/u]_ Date_[u]N/A[/u]_ Reason for Denial_[u]N/A[/u]_

[b][u]03.[/u][/b]If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other than honorable?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]04.[/u][/b] Are you now, or have you been a party to a lawsuit in the last five years?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]05.[/u][/b] Are you now, or have you been, under a restraining order(s) from any court?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]06.[/u][/b] Are you on probation or parole from any state for conviction of any offense including traffic?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]07.[/u][/b] Have you ever been convicted for any criminal offense (civilian or military) in the U.S. or any other country?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain including date, agency, and charges):

_[u]N/A[/u]_

[b][u]08.[/u][/b] Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]09.[/u][/b] Are you now, or have you ever been, addicted to a controlled substance or alcohol, or have you ever utilized an illegal controlled substance, or have you ever reported to a detoxification or drug treatment program?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]10.[/u][/b] Have you ever been involved in an incident involving firearms?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]11.[/u][/b] Have you been involved in a domestic violence incident?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_

[b][u]12.[/u][/b] Have you withheld any fact that might affect the decision to approve this license?
No_[u]_[/u]_ Yes_[u]_[/u]_ (If yes, explain):

_[u]N/A[/u]_
[/ul]

[hr]
[div style="text-align:center;"][u][font size="3"][b]SECTION 3 - DESCRIPTION OF WEAPONS[/b][/font][/u][/div]
[ul]List below the weapons you desire to carry if granted a CCW. You may carry concealed only the weapon(s) which you list and describe herein, and only for the purpose indicated. Any misuse will cause an automatic revocation and possible arrest. (Use additional pages if necessary.)

[b][u]1.[/u][/b] Make Model Caliber
[b][u]2.[/u][/b] Make Model Caliber
[b][u]3.[/u][/b] Make Model Caliber
[/ul]

[hr]
[div style="text-align:center;"][u style="font-size:10pt;"][b][font size="3"]SECTION 4 - CCW LICENSE RESTRICTION AND CONDITIONS[/font][/b][/u][/div]
[ul]The licensee is responsible for all liability for, injury to, or death of any person, or damage to any property which may result through any act or omission of either the licensee or the agency that issued the license. In the event any claim, suit, or action is brought against the agency that issued the license, its chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action.

The licensee authorizes the licensing agency to investigate, as they deem necessary, the licensee’s record and character to ascertain any and all information which may concern his/her qualifications and justification to be issued a license to carry a concealed weapon and release said agency of any and all liability arising out of such investigation.

While exercising the privileges granted to the licensee under the terms of this license, the licensee shall not, when carrying a concealed weapon:
           
[ul]• Consume any alcoholic beverage.
• Be in a place having a primary purpose of dispensing alcoholic beverages for on-site consumption.
• Be under the influence of any medication or drug, whether prescribed or not.
• Refuse to show the license or surrender the concealed weapon to any peace officer upon demand.
• Impede any peace officer in the performance of his/her duties.
• Present himself/herself as a peace officer to any person unless he/she is, in fact, a peace officer as defined by San Andreas law.
• Unjustifiably display a concealed weapon.
• Carry a concealed weapon not listed on the permit.
• Carry a concealed weapon at times or circumstances other than those specified in the permit.[/ul]

Pursuant to U.S. Government Code – Title 49, Chapter 26, Section 1472(1) and Federal Aviation Regulation 121.583, a license to carry a concealed weapon does not authorize a person to carry a firearm or any dangerous weapon aboard commercial airlines. Further, a person must declare that he/she is carrying such firearm or dangerous weapon BEFORE entering the boarding area of an air terminal where the security checks are made. Such violation can result in arrest by law enforcement.

Any violation of these restrictions or conditions may invalidate the CCW license and may void any further use of the license until reinstated by the licensing authority. Any arrest for a felony or serious misdemeanor, including driving under the influence of alcohol and/or drugs, is cause for invalidating the license.[/ul]

[hr]
[div style="text-align:center;"][u style="font-size:10pt;"][b][font size="3"]SECTION 5 - AGREEMENT TO RESTRICTIONS AND TO HOLD HARMLESS [/font][/b][/u][/div]
[ul]I accept and assume all responsibility and liability for, injury to, or death of any person, or damage to any property which may result through any act or omission of either the licensee or the agency that  issued the license. In the event any claim, suit or action is brought against the agency that issued the license, its chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action.

I understand that the acceptance of my application by the licensing authority does not guarantee the issuance of a license and that fees and costs are not refundable if denied. I further understand that if my application is approved and I am issued a license to carry a concealed weapon, that the license is subject to restrictions placed upon it and that misuse of the license will cause an automatic revocation and possible arrest and that the license may also be suspended or revoked at the discretion of the licensing authority at any time. I am aware that any use of a firearm may bring criminal action or civil liability against me.

I have read, understand, and agree to the CCW license liability clauses, conditions, and restrictions stated in this Application and Agreement to Restrictions and to Hold Harmless.

_[u][i]Firstname Lastname[/i][/u]_
[font size="2"]Applicant Signature[/font]
_[u]dd/mm/yyyy[/u]_
[font size="2"]Date[/font][/ul]

[hr]
[div style="text-align:center;"][u][font size="3"][b]SECTION 6 - REASON FOR LICENSE[/b][/font][/u][/div]
[ul]If the CCW license is desired for self-protection, the protection of others, or for the protection of large sums of money or valuable property, you are required to explain and provide good cause for issuance of the license. For example, has your life or property been threatened or jeopardized? Explain incidents and include dates, times, locations, and names of police agencies to which these incidents were reported.

[u]Details of Reason for Applicant desiring a CCW License:[/u]

<Reasoning here>

[/ul][div style="text-align:center;"][font size="3"]
[/font][/div][div style="text-align:center;"][font size="3"]
[/font][/div][hr style="text-align:center;"][div style="text-align:center;"][font size="3"]
[/font][/div][u][div style="text-align:center;"][u][font][b][font size="3"]SECTION 7 - CERTIFICATION AND RELEASE OF INFORMATIO[/font][span style="font-size:10pt;"]N[/span][/b][/font][/u][/div][/u]
[ul]I hereby give permission to the agency to which this application is made to conduct a background investigation of me and to contact any person or agency who may add to or aid in this investigation. I further authorize persons, firms, agencies and institutions listed on this application to release or confirm information about me and statements I have made as contained in this application.

Notwithstanding any other provision of law and pursuant to the Public Records Act (Government Code section 6250 et seq.), I understand that information contained in this application may be a matter of public record and shall be made available upon request or court order.

I hereby certify under penalties of perjury that the answers I have given are true and correct to the best of my knowledge and belief, and that I understand and agree to the provisions, conditions, and restrictions herein or otherwise imposed.

_[u][i]Firstname Lastname[/i][/u]_
[font size="2"]Applicant Signature[/font]
_[u]dd/mm/yyyy[/u]_
[font size="2"]Date[/font][/ul]

[hr]
[div style="text-align:center;"][u style="font-size:10pt;"][b][font size="3"](( SECTION 8 - OUT OF CHARACTER))[/font][/b][/u][/div]
[ul][b][u]01.[/u][/b] Screenshot of Character Level: [a href=""]ACCESS[/a][/ul][div style="text-align:left;"]
[/div]