Home
Inmate Roster
Most Wanted
Press Releases
Sex Offenders
Contact Us
COFFEE COUNTY
SHERIFF'S OFFICE
New Brockton, Alabama
334-894-5535
SUBMIT A CRIME TIP
SIGN UP FOR ALERTS
Departments
Administration
Aviation
Chaplain
Civil Division
Command Staff
County Stats
Criminal Investigations
Drug Task Force
Fallen Officers
History of the Sheriff
Jail
K-9
Patrol
Project Life Saver
Reserves
Road Conditions
Search & Rescue
Sex Offender Division
E-Newsletter
FAQs
Pistol Permit Application
Hot Cases
Employment
Calendar
ReCaptcha Response
Fees:
$20 for 1 Year
$100 for 5 years
$300 for Lifetime
$150 for Lifetime
(over the age of 60)
PISTOL PERMIT APPLICATION
STATE OF ALABAMA - COFFEE COUNTY
334-894-5535
Date: 10-01-2023
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:
Jefferson
Mobile
Montgomery
Autauga
Baldwin
Barbour
Bibb
Blount
Bullock
Butler
Calhoun
Chambers
Cherokee
Chilton
Choctaw
Clarke
Clay
Cleburne
Coffee
Colbert
Conecuh
Coosa
Covington
Crenshaw
Cullman
Dale
Dallas
Dekalb
Elmore
Escambia
Etowah
Fayette
Franklin
Geneva
Greene
Hale
Henry
Houston
Jackson
Lamar
Lauderdale
Lawrence
Lee
Limestone
Lowndes
Macon
Madison
Marengo
Marion
Marshall
Monroe
Morgan
Perry
Pickens
Pike
Randolph
Russell
Shelby
St. Clair
Sumter
Talladega
Tallapoosa
Tuscaloosa
Walker
Washington
Wilcox
Winston
Requesting Permit for
1 Year
5 Years
Lifetime
Physical Address:
Street Number
Street Name
Apartment Number
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
City
State
Zip
Mailing Address:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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.
10-01-2023
APPLICANT'S SIGNATURE
DATE
Uploading Form...
CRIME TIP HOTLINE
334-894-5535
OR SUBMIT VIA EMAIL
CLICK HERE
EMERGENCY - 911
PHONE 334-894-5535 (24 HOURS)