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[size=55][color=#FFFFFF].[/color][/size][/aligntable][aligntable=right,0,0,0,0,0,transparent][b]Los Santos Police Department Headquarters
1 Pershing Square, Los Santos
SA 97447


Firearms Licensing Division
License to Carry a Concealed Weapon
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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 1: Personal Information[/b][/size]

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[list][b]01. Surname:[/b] Lastname
[b]02. Forename:[/b] Firstname

[b]03. City and County of Residence:[/b] City, County
[b]04. Country of Citizenship:[/b] Country
[b]05. Date of Birth:[/b] DD/MMM/YYYY

[b]06.[/b] [color=#2E5894][b][IF US][/b][/color] [b]City, County, State of Birth:[/b] City, County, State
[b]07.[/b] [color=#2E5894][b][IF NON-US][/b][/color] [b]City, Country of Birth:[/b] City, Country

[b]08. Height:[/b] FT' IN"
[b]09. Weight:[/b] XYZ lbs.
[b]10. Eye Color:[/b] Color
[b]11. Hair Color:[/b] Color
[b]12. Gender (tick):[/b] Male [cbf][/cbf] Female [cb][/cb]
[b]13. Race (tick):[/b] White [cbf][/cbf] Black [cb][/cb] Hispanic [cb][/cb] Asian [cb][/cb] Other [cb][/cb]

[b]14. Residence Address:[/b] 1111 Street, Area, City Areacode, San Andreas
[b]15. Contact Number:[/b] 1111111
[b]16. Occupation:[/b] Occupation
[b]17. Business/Employer Name:[/b] Business Name or Forename Surname

[b]18. Link to Accepted PF Application:[/b] [url=LINK_TO_PF_APPLICATION]ACCESS[/url]
[b]19. Link to Accepted GC Application (if applicable):[/b] [url=LINK_TO_GUARD_CARD_APPLICATION]ACCESS[/url]
[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 2: Clearance Questions[/b][/size]

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[list][b]01. Do you now have, or have you ever had a license to carry a concealed weapon (CCW)?[/b]
No [cbf][/cbf] Yes [cb][/cb] (If yes, please detail below):

[b]Issuing Agency:[/b]
[b]Date:[/b]
[b]If Revoked: Reason:[/b]

[b]02. Have you ever applied for and been denied a license to carry a concealed weapon?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Agency:[/b]
[b]Date:[/b]
[b]Reason for Denial:[/b]

[b]03. If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other than honorable?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, explain):

[b]Component:[/b]
[b]Date of Discharge:[/b]
[b]Reason For Discharge:[/b]

[b]04. Are you now, or have you been a party to a lawsuit in the last five years?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, detail below and add additional fields if necessary):

[b]Category:[/b] Civil [cb][/cb] Criminal [cb][/cb] Appellate [cb][/cb]
[b]Handling Court:[/b] Superior [cb][/cb] Supreme: [cb][/cb]

[b]In progress:[/b] Yes [cb][/cb] No [cb][/cb]

[b]Was the outcome in your favor:[/b] Yes [cb][/cb] No [cb][/cb] N/A [cb][/cb]

[b]05. Are you now, or have you been, under a restraining order(s) from any court?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]06. Are you on probation or parole from any state for conviction of any offense including traffic?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]07. Have you ever been convicted for any criminal offense (civilian or military) in the U.S. or any other country?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, explain including date, agency, and charges. Add additional fields if necessary):

[b]Date of offence:[/b]
[b]Charging Agency:[/b]
[b]Charge:[/b]

[b]08. Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]09. Are you now, or have you ever been, addicted to a controlled substance or alcohol, or have you ever utilized an illegal controlled substance, or have you ever reported to a detoxification or drug treatment program?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]10. Have you ever been involved in an incident involving firearms?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]11. Have you been involved in a domestic violence incident?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]

[b]12. Is there any information not applicable to the above fields that you should declare?[/b]
No [cb][/cb] Yes [cb][/cb] (If yes, please detail below):

[b]Details:[/b]
[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 3: Description of Weapons[/b][/size]

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[list][b]List below the weapons you desire to carry if granted a CCW. You may carry concealed only the weapon(s) which you list and describe herein, and only for the purpose indicated. Any misuse will cause an automatic revocation and possible arrest.[/b]

[b]1.[/b] Make Model Caliber
[b]2.[/b] Make Model Caliber
[b]3.[/b] Make Model Caliber
[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 4: Reason for License[/b][/size]

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[list][b]If the CCW license is desired for self-protection, the protection of others, or for the protection of large sums of money or valuable property, you are required to explain and provide good cause for issuance of the license. For example, has your life or property been threatened or jeopardized? Explain incidents and include dates, times, locations, and names of police agencies to which these incidents were reported.[/b]

[b]Details of Reason for Applicant desiring a CCW License:[/b]

Answer[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 5: Rules and Restrictions[/b][/size]

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[list][b]The licensee is responsible for all liability for, injury to, or death of any person, or damage to any property which may result through any act or omission of either the licensee or the agency that issued the license. In the event any claim, suit, or action is brought against the agency that issued the license, its chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action.

The licensee authorizes the licensing agency to investigate, as they deem necessary, the licensee’s record and character to ascertain any and all information which may concern his/her qualifications and justification to be issued a license to carry a concealed weapon and release said agency of any and all liability arising out of such investigation.

While exercising the privileges granted to the licensee under the terms of this license, the licensee shall not, when carrying a concealed weapon:

[list]• Violate any of the license usage or prohibition criteria guidelines
• Consume any alcoholic beverage.
• Be in a place having a primary purpose of dispensing alcoholic beverages for on-site consumption.
• Be under the influence of any medication or drug, whether prescribed or not.
• Refuse to show the license or surrender the concealed weapon to any peace officer upon demand.
• Impede any peace officer in the performance of his/her duties.
• Present himself/herself as a peace officer to any person unless he/she is, in fact, a peace officer as defined by San Andreas law.
• Unjustifiably display a concealed weapon.
• Carry a concealed weapon not listed on the permit.
• Carry a concealed weapon at times or circumstances other than those specified in the permit.[/list]

Pursuant to U.S. Government Code – Title 49, Chapter 26, Section 1472(1) and Federal Aviation Regulation 121.583, a license to carry a concealed weapon does not authorize a person to carry a firearm or any dangerous weapon aboard commercial airlines. Further, a person must declare that he/she is carrying such firearm or dangerous weapon BEFORE entering the boarding area of an air terminal where the security checks are made. Such violation can result in arrest by law enforcement.

Any violation of these restrictions or conditions may invalidate the CCW license and may void any further use of the license until reinstated by the licensing authority. Any arrest for a felony or serious misdemeanor, including driving under the influence of alcohol and/or drugs, is cause for invalidating the license.

-

I hereby accept and assume all responsibility and liability for, injury to, or death of any person, or damage to any property which may result through any act or omission of either the licensee or the agency that  issued the license. In the event any claim, suit or action is brought against the agency that issued the license, its chief officer or any of its employees, by reason of, or in connection with any such act or omission, the licensee shall defend, indemnify, and hold harmless the agency that issued the license, its chief officer or any of its employees from such claim, suit, or action.

I understand that the acceptance of my application by the licensing authority does not guarantee the issuance of a license and that fees and costs are not refundable if denied. I further understand that if my application is approved and I am issued a license to carry a concealed weapon, that the license is subject to restrictions placed upon it and that misuse of the license will cause an automatic revocation and possible arrest and that the license may also be suspended or revoked at the discretion of the licensing authority at any time. I am aware that any use of a firearm may bring criminal action or civil liability against me.

I have read, understand, and agree to the CCW license liability clauses, conditions, and restrictions stated in this Application and Agreement to Restrictions and to Hold Harmless.[/b]

[b]Signature:[/b] [img]SIGNATURE_IMAGE[/img]

[b]Print Name:[/b] FULL NAME BLOCK CAPITALS

[b]Date:[/b] DD/MMM/YYYY[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b]Section 6: Certification of Understanding[/b][/size]

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[list][b]I hereby give permission to the agency to which this application is made to conduct a background investigation of me and to contact any person or agency who may add to or aid in this investigation. I further authorize persons, firms, agencies and institutions listed on this application to release or confirm information about me and statements I have made as contained in this application.

Notwithstanding any other provision of law and pursuant to the Public Records Act (Government Code section 6250 et seq.), I understand that information contained in this application may be a matter of public record and shall be made available upon request or court order.

I hereby certify under penalties of perjury that the answers I have given are true and correct to the best of my knowledge and belief, and that I understand and agree to the provisions, conditions, and restrictions herein or otherwise imposed.[/b]

[b]Signature:[/b] [img]SIGNATURE_IMAGE[/img]

[b]Print Name:[/b] FULL NAME BLOCK CAPITALS

[b]Date:[/b] DD/MMM/YYYY[/list]

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[img]http://i.imgur.com/dUCxWca.png[/img] [size=130][b](( Section 7: Out of Character ))[/b][/size]

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[list][b]01. Screenshot of Character Level:[/b] [url=LINK TO SCREENSHOT]ACCESS[/url]

[b]02. Screenshot of Streetname (/myhouse or /streetname):[/b] [url=LINK TO SCREENSHOT]ACCESS[/url]

[b]03. LS:RP Forum Name:[/b] [url=LSRP_PROFILE_LINK]LSRP_FORUM_NAME[/url]
[/list]
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