Form Sp-248 - Application For Concealed Handgun Permit
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4SP-248 (7-1-2013)
FILE NUMBER:
APPLICATION FOR CONCEALED HANDGUN PERMIT
RESIDENT PERMIT
COMMONWEALTH OF VIRGINIA
NONRESIDENT PERMIT
________________________________
VIRGINIA CODE SECTIONS 18.2-308.02
06
RENEWAL
AND
2
3
SEE NOTICE
PAGE
1.
2.
FULL LEGAL NAME
DATE OF BIRTH
(
)
(
21
)
ATTACH A S EP ARATE LISTING OF ANY ADDITIONAL NAMES YOU MAY HAVE US ED OR BEEN KNOWN BY
YOU MUST BE AT LEAS T
YEARS OF AGE
___________________________
______________________
___________________________________
______
_____
________
FIRST
MIDDLE
LAST
MONTH
DAY
YEAR
3.
RESIDENTIAL ADDRESS
(
5
)
ATTACH A S EP ARATE LISTING OF ALL ADDRES S ES WITHIN THE LAST
YEAR P ERIOD
____________________________________
______________________________
____________________________
_________
____________
STREET OR RURAL ROUTE
CITY
COUNTY
STATE
ZIP
MAILING ADDRESS
______________________________________________________________________
_________________________________
EMAIL
(
)
(
)
IF DIFFERENT
OPTIONAL
4.
5.
PHYSICAL FEATURES
SOCIAL SECURITY NUMBER
(
)
OPTIONAL
1
3
SEE NOTICE
ON PAGE
_____
______
_____
_____
________
__________
HEIGHT
WEIGHT
SEX
RACE
HAIR COLOR
EYE COLOR
,
,
,
: ___________________________________________________________
SCARS
MARKS
TATTOOS
PECULIAR CHARACTERISTICS
6.
7.
PLACE OF BIRTH
COUNTRY OF CITIZENSHIP
TELEPHONE NUMBER
(
.
YOU MUST BE A UNITED STATES CITIZEN OR HAVE LAWFUL PERMANENT RES IDENCE
(
/
/
)
LOCALITY
STATE
NATION
-
-
.)
NON
CITIZEN AP P LICANTS MUST P ROVIDE A VALID INS
IS S UED ALIEN REGISTRATION NUMBER
___________________
UNITED STATES
HOME
_____________________________
__________________
: __________________________
:__________________________
OTHER
OTHER
ALIEN REGISTRATION NUMBER
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
YES
NO
,
.
,
1
2.
WHICH YOU WERE CONVICTED AS A JUVENILE
WHICH WOULD HAVE BEEN A FELONY IF COMMITTED BY AN ADULT
IF YES
COMPLETE FORM
PART B PAGE
.
FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT
.
-
? (
2
HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OFFENSE WITHIN THE FIVE
YEAR PERIOD IMMEDIATELY PRECEDING THIS APPLICATION
INCLUDE
YES
NO
.
MISDEMEANOR CONVICTIONS OF DRIVING UNDER THE INFLUENCE
DO NOT INCLUDE TRAFFIC INFRACTIONS OR THOSE MISDEMEANORS SET FORTH IN TITLE
46.2
.)
,
1
2.
CODE OF VIRGINIA
IF YES
COMPLETE FORM
PART B PAGE
FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALSE
.
STATEMENT
.
?
HAVE YOU BEEN COMMITTED TO THE CUSTODY OF THE COMMISSIONER OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
B
YES
NO
,
2
2 (
4
3)
IF YES
COMPLETE FORM
PART A PAGE
SEE NOTICE
PAGE
,
,
.
C
HAVE YOU BEEN ACQUITTED BY REASON OF INSANITY
ADJUDICATED LEGALLY INCOMPETENT
MENTALLY INCAPACITATED OR ADJUDICATED AN INCAPACITATED
YES
NO
?
PERSON BY A COURT OF VIRGINIA OR ANY OTHER COURT
,
2
2. (
4
3)
IF YES
COMPLETE FORM
PART B PAGE
SEE NOTICE
PAGE
.
,
D
HAVE YOU BEEN INVOLUNTARILY ADMITTED TO A FACILITY OR ORDERED TO MANDATORY OUTPATIENT TREATMENT
OR WERE YOU THE SUBJECT OF A TEMPORARY
YES
NO
.
§ 37.2-809
.
§ 37.2-805?
,
DETENTION ORDER PURSUANT TO VA
CODE
WHO LATER AGREED TO VOLUNTARY ADMISSION UNDER VA
CODE
IF YES
COMPLETE FORM
2
2
. (
4
3)
PAGE
AS INDICATED BELOW
SEE NOTICE
PAGE
2
2
1.
COMPLETE PART C OF FORM
PAGE
IF INVOLUNTARILY ADMITTED
2
2
2.
COMPLETE PART D OF FORM
PAGE
IF ORDERED TO MANDATORY OUTPATIENT TREATMENT
2
2
3.
COMPLETE PART E OF FORM
PAGE
IF VOLUNTARILY ADMITTED SUBSEQUENT TO A TEMPORARY DETENTION ORDER
.
E
HAVE YOU RECEIVED MENTAL HEALTH TREATMENT OR SUBSTANCE ABUSE TREATMENT IN A RESIDENTIAL SETTING WITHIN THE FIVE YEARS PRIOR TO THE DATE OF
YES
NO
?
THIS APPLICATION
.
,
?
F
ARE YOU THE SUBJECT OF
OR NAMED AS A RESPONDENT IN A RESTRAINING ORDER OR A PROTECTIVE ORDER
AN ACTIVE RESTRAINING OR PROTECTIVE ORDER
YES
NO
.
.
§ 18.2-308.1:4.
MAY BE AN AUTOMATIC DISQUALIFER IN VIRGINIA
SEE VA
CODE
,
?
.
G
ARE YOU ADDICTED TO
OR AN UNLAWFUL USER OR DISTRIBUTOR OF MARIJUANA OR ANY CONTROLLED SUBSTANCE
YES
NO
.
?
ARE YOU AN ALIEN NOT LAWFULLY ADMITTED FOR PERMANENT RESIDENCE IN THE UNITED STATES
H
YES
NO
.
?
I
HAVE YOU BEEN DISCHARGED FROM THE ARMED FORCES OF THE UNITED STATES UNDER DISHONORABLE CONDITIONS
YES
NO
?
.
J
ARE YOU A FUGITIVE FROM JUSTICE
YES
NO
?
,
1
2.
.
K
DO YOU HAVE ANY CRIMINAL CHARGE PENDING
IF YES
COMPLETE FORM
PART A PAGE
YES
NO
.
FAILURE TO ACKNOWLEDGE A P ENDING CHARGE MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT
.
,
-
,
1)
-
L
HAVE YOU
WITHIN THE THREE
YEAR PERIOD IMMEDIATELY PRECEDING THE DATE OF THIS APPLICATION
EITHER
BEEN FOUND GUILTY OF ANY DRUG
RELATED
YES
NO
1 (§ 18.2-247
.)
7
18.2
CRIMINAL OFFENSE AS SET FORTH IN ARTICLE
ET SEQ
OF CHAPTER
OF TITLE
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
;
2)
UNITED STATES OR ITS TERRITORIES
OR
BEEN CHARGED WITH ANY OFFENSE ENUMERATED IN THIS PARAGRAPH AND THE TRIAL COURT FOUND THE FACTS OF
§ 18.2-251
,
THE CASE WERE SUFFICIENT FOR A FINDING OF GUILT AND DISPOSED OF THE CASE PURSUANT TO
OR SUBSTANTIALITY SIMILAR LAW OF VIRGINIA
ANY
,
,
?
,
1
2.
OTHER STATE
THE DISTRICT OF COLUMBIA
OR THE UNITED STATES OR ITS TERRITORIES
IF YES
COMPLETE FORM
PART A OR B PAGE
?
.
M
DO YOU CURRENTLY HAVE A VALID RESIDENT CONCEALED HANDGUN PERMIT ISSUED BY A VIRGINIA CIRCUIT COURT
YES
NO
,
: ________________________________________
______________
IF YES
NAME OF THE CIRCUIT COURT WHICH ISSUED THE PERMIT
EXPIRATION DATE
9.
(
).
ATTACH A PHOTOCOPY OF THE DOCUMENTATION THAT DEMONSTRATES YOUR COMPETENCE WITH A HANDGUN
INITIAL PERMITS ONLY
,
,
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
§18.2-434
.
ACCORDANCE WITH
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
/
/
NOTARY PUBLIC
#
MONTH
DAY
YEAR
MY COMMISSION EXPIRES
REGISTRATION
:
COURT CLERK
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