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Fee $20.00/year
PISTOL PERMIT APPLICATION
STATE OF ALABAMA - COFFEE COUNTY
334-894-5535

Date: 07-25-2017
 
  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, Code of Alabama, 1975). A criminal history background check will be conducted on each applicant.  

Full Name:    
Last Middle First
     
Other Names You Have Been Known By:  
   
County of Residence: Requesting Permit for year(s) (may apply for up to five (5) years)
     
Physical Address:    
Street Number Street Name Apartment Number
     
 
City
State
Zip
 
     
Mailing Address:    
Address City
State
Zip
     
Phone Numbers:   Email Address:
Home Cell  
     
Age: Date of Birth: Place of Birth: Are You a U.S. Citizen? Yes No
 
     
Sex: Race: Height: Weight: Hair Color: Eye Color:
Male
Female
     
Driver's License Number: Other State ID: Social Security Number:
     
Yes No Have you ever had a pistol permit?
If so, where and when?
Yes No Have you ever had a pistol permit revoked or denied?
If so, where and when?
Yes No Have you ever been convicted of a crime?
Yes No Are you now or have you ever been under an indictment?
Yes No Are you now or have you ever been treated for a mental illness or substance abuse (drugs/alcohol)?
Yes No Are you now or have you ever been under a restraining order to prevent endangering yourself or others?
Yes No Are you awaiting trial as a defendant in any criminal case?
Yes No Have you been found guilty by reason of mentally illness in a criminal case?
Yes No Have you been found not guilty in a criminal case by reasons of insanity or mental disease or defect?
Yes No Have you been declared incompetent to stand trial in a criminal case?
Yes No Have you asserted a defense in a criminal case of not guilty by reason of insanity or mental disease or defect?
Yes No Have you been found not guilty by reason of lack of mental responsibility under the Uniform Code of Military Justice?
Yes No 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?
Yes No Have you required involuntary commitment to a psychiatric hospital or similar treatment facility for any reasons, including drug use?
Yes No Have you been the subject of a prosecution or of 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, please use the space below to provide dates and places of arrests or treatment, charges, agency involved and dispositions.
     
I HEREBY CERTIFY THAT MY ANSWERS ARE TRUE, COMPLETE AND CORRECT AND I UNDERSTAND THIS APPLICATION WILL BE REJECTED IF ANY INFORMATION IS FOUND TO BE FALSE OR MISLEADING.
 
07-25-2017
APPLICANT'S SIGNATURE DATE
 
 
 
 
 
 
CRIME TIP HOTLINE 334-894-5535
OR SUBMIT VIA EMAIL CLICK HERE
 
EMERGENCY - 911
PHONE 334-894-5535 (24 HOURS)