Pistol Permit - Coffee County Sheriff AL

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New Brockton, Alabama

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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:

Requesting Permit for

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.

10-01-2023

APPLICANT'S SIGNATURE

DATE

CRIME TIP HOTLINE 334-894-5535
OR SUBMIT VIA EMAIL CLICK HERE

EMERGENCY - 911
PHONE 334-894-5535 (24 HOURS)