SHERIFF OF LEE COUNTY

JAY JONES

P.O. Box 688

Opelika, AL.  36803-0688
                                                                    

 PISTOL PERMIT APPLICATION

Read the following carefully and provide complete and accurate information.  It is a CRIME to make a false statement or report to law enforcement. (Title 13A-10-109 Alabama Code).  A criminal history background check will be conducted on each applicant.

Please list the reason you are applying for a permit: 

Last Name:  First Name:    Middle Initial: 

Address: 

City:   State:    Zip code:  

Home Phone:   Cell Phone:

Email Address: 

Social Security Number: --

Age:   Date of Birth:   /   /   Race: Sex: Male  Female

Height:   Weight:  Hair Color:    Eye Color: 

Drivers License Number:   State: 

Place of Birth:   Employer: 

Occupation:    Work Phone Number: 

Make of Gun:   Serial Number:   Caliber:

Have you ever had a pistol permit?  Yes  No  If so, where? 

*** Have you ever had a pistol permit revoked?  Yes  No     When?

1.  Have you ever been taken into custody by a law enforcement agency?  Yes  No

2.  Have you ever been arrested or charged with a crime?  Yes  No

3.  Have you ever been treated for mental illness?  Yes  No

4.  Have you ever been treated for substance abuse (drugs/alcohol)?  Yes  No

5.  Are you addicted to alcohol, prescription medicine or illegal drugs?  Yes  No

6.  Are you on probation or under a restraining order from ANY court?  Yes  No

7.  Are you awaiting trial as a defendant in any criminal case?  Yes  No

If you answered YES to any of the questions above, please use the space below to provide dates and places of arrest or treatment, charges, agency involved and dispositions.

1.

2.

3.

4.

5.

6.

7.

I certify that my answers are true and correct to the best of my knowledge:

Name:        Date:  /  /

  IF THIS APPLICATION IS SUBMITTED SUCCESSFULLY YOU WILL BE TAKEN TO OUR HOMEPAGE.