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Check if you are an ACTIVE DUTY PEACE OFFICER, as defined in Chapter 4.5, (commencing with section 830) of Title
3 of Part 2 of the Penal Code, or a federal qualified law enforcement officer, as defined in section 926B of Title 18 of the United
If you check the box, see Instructions.
IMPORTANT INFORMATION - READ CAREFULLY: I understand that a BSIS firearms permit authorizes me to
carry an exposed (i.e. non-concealed) loaded firearm only of the caliber(s) listed on my permit card and only while
performing the duties of the license associated with the permit. I also understand that a BSIS firearms permit
does not authorize me to carry a concealed loaded firearm. Lastly, I understand that if I am a private patrol
operator or alarm company operator licensee; a registered security guard or alarm agent, or a qualified manager
for a private patrol operator or alarm company operator licensee, I can only wear or use an exposed firearm while
on duty when in uniform.
Mandatory Disclosure Language
Submission of the requested information is mandatory. The Bureau of Security and Investigative Services (BSIS) of the
Department of Consumer Affairs (Department) cannot process your Firearms Permit Initial
Application unless all requested
information is provided.
Per the Information Practices Act, the Chief of the BSIS is responsible for maintaining the information in this application. You
have the right to review the records maintained on you by the BSIS or Department unless the records are exempt from
disclosure by section 1798.40 of the Civil Code. Your completed application becomes the property of the BSIS and will be used
by authorized personnel to determine your eligibility for a license, registration or permit. Information on your application may
be transferred to other governmental or law enforcement agencies, as permitted by law.
Pursuant to the California Public Records Act (Gov. Code § 6250 et seq.) and the Information Practices Act (Civ. Code §
1798.61), the names and addresses of persons possessing a license, certificate, permit or registration may be disclosed by the
BSIS unless otherwise specifically exempt from disclosure under the law. The BSIS makes every effort to protect the exempt
personal information you provide us. The information
you provide, however, may be disclosed in response to a court or
administrative order, a subpoena, or a search warrant.
Pursuant to Business and Professions Code section 30, providing your social security number is mandatory and will be used
primarily for tax enforcement purposes and for compliance with any judgment or order for family support in accordance with
section 17520 of the Family Code. Your social security number may also be used for verification of licensure or examination
status for national examination where licensure is reciprocal with a requesting state. If you fail to provide your social security
number, you will be reported to the Franchise Tax Board (FTB), which may assess a $100 penalty against you. Further,
pursuant to section 30, su
bdivision (n) your social security number together with your name, date of birth, and license
information may be shared with the Office of the Chancellor of the California Community Colleges.
The State Board of Equalization (BOE) and the FTB may share taxpayer information with the BSIS. You are required to pay
your state tax obligation. This application may be denied or your license may be suspended if the state tax obligation is not paid
and your name appears on either the BOE or FTB certified list of top 500 tax delinquencies.
For questions about this notice or access to your record, you may contact the BSIS
by mail at Bureau of Security and
Investigative Services, Attn: Public Records Liaison, P.O. Box 980550, Sacramento, CA 95798-0550; by phone at (800) 952-
5210; or by e-mail at
of Consumer Affairs at 1625 North Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-5210 or by e-mail at
I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT:
• I personally completed this application;
• To the best of my knowledge all statements on this application are true and correct;
• I have completed the training requirements (i.e. range for each caliber, classroom and exam) to obtain a BSIS firearms
permit or am an active duty peace officer who has successfully completed a firearms training course;
• I am not presently subject to any State of California or Federal prohibition from owning or being in possession of a firearm;
• With full knowledge that all statements herein are subject to investigation and that any false, dishonest, or incomplete
answer to any question on the application may be grounds for denial or subsequent revocation of my firearms permit and
any other license(s) I hold, or may subject me to criminal prosecution.