Fillable CCW App Fillable Aug 2019

Fill Online, Printable, Fillable, Blank CCW App Fillable Aug 2019 Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

CCW App Fillable Aug 2019

On average this form takes 25 minutes to complete

The CCW App Fillable Aug 2019 form is 7 pages long and contains:

  • 0 signatures
  • 46 check-boxes
  • 78 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Las Vegas Metropolitan Police Department
CONCEALED FIREARM PERMIT APPLICATION
Submit completed application in person at:
Rev 8/19
Las Vegas Metropolitan Police Department
RECORDS & FINGERPRINT BUREAU
(702)828-3271
400 S Martin Luther King Blvd - Bldg C Las Vegas, NV
89106
Monday – Friday: 7:00 am – 6:00 pm
Saturday, Sunday, & Holidays: 08:00 am - 5:00 pm (Closed Thanksgiving & Christmas)
Current fees and payment methods accepted are available at www.lvmpd.com/permits
GENERAL INFORMATION & INSTRUCTIONS
1.
REQUIRED TRAINING
Applicants must complete a Basic Firearms Course approved by the Sheriff and conducted by a certified instructor.
Please refer to www.lvmpd.com/permits regarding course eligibility.
2. COMPLETING THE APPLICATION: PRINT LEGIBLY OR TYPE IN BLACK INK
a. Complete all pages of the application packet (all signatures should be completed in the presence of the
Fingerprint Bureau personnel).
b. Indicate your full name as it appears on your government issued identification. Include any previous names used
( i.e. maiden name, married names and any legal name changes).
c. List your current address in the “PHYSICAL ADDRESS” space; PO boxes and work addresses are not acceptable.
If the mailing address is different from the physical address, please provide the information in the “MAILING
ADDRESS” space (PO boxes and work addresses are acceptable as a mailing address). In the address history
section, list all complete addresses where you have resided during the last 10 years (five years for renewal
applications), including present address. PO boxes and work addresses are not acceptable.
d. A background investigation will be conducted on each applicant. Should any information not be verifiable (such
as dispositions of criminal charges) it is the responsibility of the applicant to provide required information.
3. ITEMS TO BRING WITH YOU
a. U.S. Citizens- State (DMV) issued identification (i.e. driver’s license, identification card). Your identification must
reflect the address where you currently reside. If you have recently become a Nevada resident, you must
surrender the driver’s license of your prior state of residency to the Nevada Department of Motor Vehicles and
obtain a Nevada driver’s license prior to submitting your application.
b. Naturalized Citizens or Foreign Born Citizens- Persons born outside of the United States MUST provide original
documentation of US citizenship or permanent residency. A Naturalization Certificate or Permanent Resident
Alien Registration Card issued by Citizenship and Immigration Services, a current unexpired US Passport, or a
certificate of birth issued by a United States Consulate (Certificate of Report Born Abroad) are acceptable forms
of documents; expired US Passports and military/hospital birth certificates are not acceptable.
c. Legal Aliens (Immigrant, Legal Permanent Resident, and Non-Immigrant)- Proof of lawful alien status must be
provided and must be possessed to prove lawful possession of firearms. You must also provide proof of your
current residence.
i. Immigrant Alien & Legal Permanent Resident- A copy of your Alien card, which must not be
expired and include an AR#, USCIS#, or A#
ii. Non-Immigrant Alien- A copy of your Visa or Employment Authorization card (if required by
DHS), valid Passport, I-94, AR# or A# (You also may require a valid hunting license, based
upon visa type)
iii. All parties, for this section, must meet the requirements listed in 18 U.S.C. 922 (d)(5), (g)(5)
and (y)(2); 27 CFR 478.11 and 478.32(a)(5), in order to lawfully possess firearms in the U.S.
Page 1 of 7
Las Vegas Metropolitan Police Department
CONCEALED FIREARM PERMIT APPLICATION
4. RENEWALS
You may begin the renewal process for your permit at any time, but no credit will be provided for unused time. We
recommend starting the process 120 days BEFORE the permit expires. This will ensure the continuity of your permit.
An additional, non-refundable late fee will be assessed on all renewals that have expired. If a permit has been
expired more than 365 days, the application for renewal shall be treated as an initial application. Renewal
applications require the same documentation as an initial application.
5. DUPLICATE/CHANGE OF ADDRESS/CHANGE OF NAME
a. Duplicate: A non-refundable fee is required to replace a lost, stolen or destroyed permit. Additionally, an
affidavit or written statement must be completed.
b. Change of Address: Under Nevada law, you are required to notify this office in writing within 30 days of
changing your address. Failure to comply will result in a penalty fee being assessed.
c. Change of Name: A non-refundable fee is required to change your name on your permit.
6.
FEES
A non-refundable fingerprint and investigation processing fee is required at the time of application; please refer to
the LVMPD website www.lvmpd.com/permits for current fee information and payment types accepted.
7. ELIGIBILITY
a.
You are NOT eligible to carry a Concealed Firearm Permit if any of the following apply:
1.
You are under 21 years of age, unless you meet the military exemption.
2.
You do not provide the required documentation to demonstrate competence with a firearm.
3.
You are a fugitive from justice.
4.
You have been judicially declared mentally incompetent or insane.
5.
You have been admitted to a mental health facility, within the last 5 years
6.
You have habitually used intoxicating liquor or a controlled substance to the extent that your normal
faculties are impaired, including DUI convictions within five previous years and Medical Marijuana Patients.
7.
You have been convicted of a crime involving the use, or threatened use of force or violence, including
misdemeanor convictions, within the last three (3) years.
8.
You have been convicted of a felony.
9.
You have been convicted of a crime involving domestic violence or stalking, or you are currently subject to a
restraining order or other order of protection against violence.
10.
You are currently on parole or probation.
11.
You have been, within the preceding five (5) years, subject to any requirements imposed by a court as a
condition to:
a.
Withholding the entry of judgment for your conviction of a felony, or
b.
Suspension of your sentence for the conviction of a felony, or
c.
Indictment by a Grand Jury.
12.
You have made a false statement on any application.
13. You were dishonorably discharged from the Armed Forces.
14. You are not lawfully admitted into or are no longer lawfully within the United States.
15. You are prohibited from possessing a firearm under state and federal law, city and/or county ordinances.
8. ISSUANCE OF PERMIT
Allow 120 days for your permit to be issued; this applies to both initial and renewal permit applications. Upon
approval, your permit will be mailed to you. In the event your application is denied, you will be notified in writing,
stating the reason(s) for denial. You may seek judicial review of the denial by filing a petition in District Court.
9. CARRYING OF PERMIT
Your concealed firearms permit is valid throughout the State of Nevada. For specific prohibited locations, refer to
Nevada Revised Statute 202.3673. When you are in possession of a concealed firearm, you must carry the permit
and your driver’s license/state identification. Both the permit and proper identification must be presented if
requested by a peace officer.
Page 2 of 7
Las Vegas Metropolitan Police Department
CONCEALED FIREARM PERMIT APPLICATION
APPLICANTS ARE ADVISED:
1.
This application is an official document; falsification or misrepresentation of any part, or any document
attached hereto subjects the applicant to denial.
If there is evidence of an intentional falsification or omission, the applicant may be charged with
Forgery, which is a category C felony.
2. It shall be the responsibility of the applicant to familiarize himself/herself with the provision of the
Statutes, Ordinances, Rules and Regulations pertaining to the privilege of carrying a concealed firearm,
and in particular with the provisions of Sections 200.120, 200.130, 200.160, 200.200, 202.253, 202.257,
202.265, 202.280, 202.285, 202.290, 202.300, 202.320, 202.350, 202.360 and 202.3653 to 202.3677,
inclusive of the Nevada Revised Statutes; any applicable local ordinances; Federal Law: Title 18 U.S.
Code, Section 922 (d)(5), (g)(1-9), (n), and (y)(2); 27 CFR 478.11 and 478.32(a)(5)
Page 3 of 7
LVMPD USE ONLY:
Date: __________________
Las Vegas Metropolitan Police Department
CS # ___________________
CONCEALED FIREARM PERMIT APPLICATION
Initial Application Renewal Application
Please type or print legibly in BLACK ink
First Name:
Middle Name:
List all names ever used, including maiden name, any married names and any legal name changes:
2.
1.
3.
4.
SSN: Birthdate: Citizenship: Place of Birth:
Permanent
Resident
, Alien Registration, or Alien
ID#:
Visa, Permanent Resident, Alien Registration, or Alien
ID#
Expiration
:
Sex: M F Race: White Black Hispanic Asian Indian Other
Height:
Weight:
Hair Color:
Eye Color:
Physical Address
(including Bldg/Apt#):
City:
State:
Zip:
Mailing Address
(including Bldg/Apt#):
City:
State:
Zip:
Home Phone:
Cell Phone:
Employer:
Work Pho
ne:
Employer Address: Occupation:
Answer each of the following questions by checking the appropriate box:
1.
Are there currently any outstanding warrants for your arrest?.....................................................................
2.
Have you ever been judicially declared mentally incompetent or insane?....................................................
3.
Have you ever been admitted to a mental health facility?...............................................................................
4.
During the five years immediately preceding the date of this application, have you been convicted of
driving under the influence of alcoholic or controlled substance(s) in this or any other state?....................
5.
During the five years immediately preceding the date of this application, have you habitually used
intoxicating liquor or narcotics to the extent that your normal faculties were impaired?............................
6.
During the five years immediately preceding the date of this application, have you been committed for
treatment of the abuse of alcoholic beverages or narcotics in this or any other state?.................................
7.
During the five years immediately preceding the date of this application, have you been committed for
treatment of, or convicted of a crime related to controlled substance in this or any other state?...............
8.
During the three years immediately preceding the date of this application, have you been convicted of a
crime involving the use or threatened use of force or violence, punishable as a misdemeanor?.................
9.
Have you ever been convicted of a felony in this or any other state?........................................................
10.
During the five years immediately preceding the date of this application, have you been subject to any
requirements imposed by a court as a condition to the courts withholding the entry of judgment of
suspension of a sentence, for the conviction of a felony?..............................................................................
11.
Have you ever been convicted of a crime involving domestic violence or stalking in this or any other state?
12.
Are you currently subject to a restraining order, injunction or other order for protection against domestic
violence in this or any other state?.................................................................................................
13.
Are you currently on parole or probation for a conviction in this or any other state?....................................
14.
Have you ever renounced your United State’s citizenship?..............................................................................
15.
Have you been dishonorably discharged from the Armed Forces?................................................................
16.
Are you between the ages of 18 and 21 and meet the military exemption to obtain a permit? ................
17.
During the year immediately preceding this application, have you used marijuana?..................................
YES
NO
Page 4 of 7
Las Vegas Metropolitan Police Department
CONCEALED FIREARM PERMIT APPLICATION
If you answered “YES” to any of the questions on the previous page, please explain below (add additional pages if necessary).
Street Address Dates of Residency
City & State
(including Bldg/Apt#) Mo/Yr
-
Mo/Yr
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
AFFIDAVIT
To be completed in the presence of an LVMPD Employee.
This application is executed under oath. Falsification or misrepresentation of any part, or any document attached
subjects the applicant to denial or revocation of the permit for which this application is submitted.
Before me this day personally appeared
who being duly sworn, deposes and says:
(Applicant’s Name)
I DO HEREBY SWEAR AND AFFIRM, UNDER PENALTY OF PERJURY, THAT THE FOLLOWING ASSERTIONS ARE
TRUE AND CORRECT:
A. The information contained in this application and all attached documents are true and correct to the best of my
knowledge.
B. I agree to immediately notify the issuing agency’s Concealed Weapons Detail if charged, arrested, or convicted of any
crime in this state or under the laws of any state, territory or possession of the United States.
Date: Signature of Applicant:
FOR LVMPD USE ONLY – IDENTIFICATION VERIFICATION
STATE/DMV Issued Identification:
0
Driver’s License # or
0
State Identification ID #
Exp Date: State:
0
Retain Copies For Below
US Passport #
Exp Date:
0
Naturalization# 0 Alien ID/Resident#
LVMPD Employee: P#:
Page 5 of 7
List all residences, beginning with the current address, for the past 10 years (5 years for renewal applicants):
Las Vegas Metropolitan Police Department
CONCEALED FIREARM PERMIT APPLICATION
WAIVER AND AUTHORIZATION TO RELEASE INFORMATION
To whom it may concern:
I authorize you to furnish the Las Vegas Metropolitan Police Department with any and all information that you
have concerning me, my employment records, my reputation, my mental health condition, and my military
service records. Information of a confidential or privileged nature may be included. Your reply will be used to
assist the police department in determining my qualification and suitability for a Concealed Firearms Permit.
In compliance with Federal Confidentiality Rules (42 CFR, Part 2), this waiver includes the release of medical
records for the admission and discharge dates to a mental health facility for treatment of mental health.
In addition to the above requested information, you may release arrests, detentions, field citations, field
interview cards, officers’ records, jail/custody booking records, traffic citations, and traffic accident information,
district attorney records, court records and reports, probation and parole reports and records, laboratory
reports and results, and any other criminal justice records, reports or information source.
This authorization and request is given freely and without duress, voluntarily waiving any protection against
unauthorized disclosure of information under the Privacy Act and any other legal provisions, and with the
understanding that information furnished will be used by the Las Vegas Metropolitan Police Department in
conjunction with my application for a Concealed Firearms Permit.
I hereby release you, your organization and others from any liability or damage which may result from furnishing
the information requested, including any liability pursuant to any state or local code or ordinance or any similar
laws.
I declare under penalty of perjury under the laws of the State of Nevada, that the foregoing is true and correct.
Applicant’s Full Name (
please type or print legibly in black ink) -
Applicant’s Signature
Date
LVMPD
Employee
Date
NOTE: A photocopy reproduction of this request shall be, for all intents and purposes, as valid
as the original. You may retain a copy of this form for your files.
Page 6 of 7
____________________________________________________________
____________________________________________________________
Nevada Sheriffs and Chiefs
Firearms Safety Course
Certification of Completion
and Firearms Proficiency Certificate
(TO BE COMPLETED BY INSTRUCTOR ONLY)
Issued to: _________________________________________
Date: _______________________
Applicant's Name
I, ______________________________________, an instructor for _____________________________
Instructor’s Name – Please Print Clearly Name of Business – Please Print Clearly
certify that the above named applicant has completed a course of instruction to include the following:
Applicant
Instructor
Initials
Initials
Successfully completed a course of instruction and demonstrated proficiency in basic firearm knowledge
and the safe handling of firearms.
Successfully completed a course of instruction and demonstrated proficiency in ammunition knowledge
and the safe handling of ammunition.
Successfully completed a course of instruction and demonstrated proficiency in the cleaning and the care
of firearms.
Successfully completed a course of instruction and demonstrated proficiency in storage and child proofing
firearms.
Successfully completed a course of instruction and demonstrated proficiency in handgun shooting
techniques and positions.
Successfully completed a course of instruction in the laws pertaining to the use of firearms in the State of
Nevada and the County in which the application is submitted.
Successfully completed a course of instruction in the use of deadly force, the force continuum, civil and
criminal liability.
Successfully completed a course of instruction in the knowledge of avoiding criminal attack and
controlling a violent confrontation.
Successfully completed a course of instruction and demonstrated proficiency in firing a handgun and
range safety.
Successfully completed and passed a written examination and a firearms qualification course as required.
Check all that apply
Full Course (8 Hours):
If Full Course , Written Test: Pass
Fail
Renewal Course (4 Hours)
This certificate satisfies the State of Nevada's CCW Permit Instruction Requirements.
Location of Classroom and Range (please include County):
______________________________________________________ Date: ___________ Times: ________ to __________
Classroom Address
______________________________________________________ Date: ___________ Times: ________ to __________
Range Address
Instructor Signature
Under penalty of Perjury, I attest that I have completed an approved course of instruction and qualified with
a handgun. I understand filing a false application is an act of Forgery and a violation of Nevada law.
LVMPD CCW Form
Applicant Signature
Rev 8/2019
Page 7 of 7
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

CCW App Fillable Aug 2019

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document