Nicolet Area Technical College, REV. 11/2016 Page 1 of 2
Firearms Release of Information
(This form is intended to certify legal residence and/or operator legality of a firearm for
use/possession in the Law Enforcement Academy)
Note to Applicant: Complete the entire form (including signature) and return to the NATC Law
nforcement Academy along with your other Academy Application Forms.
Legal Name (Last, First, MI) Sex Race Date of Birth
Other Name(s) used now or at any time in the past (e.g., maiden/alias)
Residence Address City State Zip
Answer each question with a “YES” or “NO” in the box at the right of the question. YES NO If YES, Explain
1. Have you ever been convicted of a felony in this state or a crime
elsewhere that would be a felony if committed in Wisconsin? (A
felony is any crime for which you could have been imprisoned for
more than one year even if you were not imprisoned or served less
than one year.)
2. Have you ever been found or adjudicated not guilty of a felony in
Wisconsin or any other jurisdiction by reason of insanity, mental
disease, defect or illness?
3. Have you ever been adjudicated delinquent as a juvenile for an act
committed on or after April 21, 1994, that if committed by an adult
in Wisconsin would be a felony and have not been exempted from
the firearm prohibition by order of a court pursuant to S 941.29 (8)?
4. Are you subject to a court order under the Wisconsin Mental Health
Act (Ch. 51) prohibiting you from possessing a handgun?
5. Are you subject to a court order under the harassment injunction
law (sec. 813.125) prohibiting you from possessing a firearm?
6. Are you subject to a domestic abuse injunction or domestic abuse
tribal injunction (sec. 813.12) or a child abuse injunction (sec.
7. Are you under indictment or information in any court for a felony, or
any other crime, for which the judge would imprison you for more
than one year? (An information is a formal accusation of a crime by a prosecutor. See
8. Are you a fugitive from justice?
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9. Are you an unlawful user of, or addicted to, marijuana, or any
depressant, stimulant, or narcotic drug, or any other controlled
10. Have you ever been adjudicated mentally defective (which includes
having been adjudicated incompetent to manage your own affairs) or
have you ever been committed to a mental institution?
11. Have you been discharged from the Armed Forces under
dishonorable conditions?
12. Have you been convicted in any court of a misdemeanor crime of
domestic violence?
13. Have you ever renounced your United States citizenship?
14. Are you an alien illegally in the United States?
15. Are you a United States citizen?
I certify that all statements on this form are true. I understand that if I knowingly make a false
statement, I may be subject to penalties, fines, and/or imprisonment under WI Statutes and/or
provide o
r assist in providing any firearm to a minor, except under certain conditions as set forth in the Wisconsin statutes,
and under any circumstances to provide or assist in providing any firearm to a convicted felon or any other person prohibited
by law from possessing a firearm under s 941.29.)
Telephone Number: ________________________ Date________________________
Under indic
tment or information or convicted in any court: An indictment, information, or conviction in any
Federal, State, local, or foreign court.
Misdemeanor Crime of Domestic Violence: A Federal, State, or local offense that is a misdemeanor under Federal
or State law and has, as an element, the use or attempted use of physical force, or the threatened use of a deadly
weapon, committed by a current or former spouse, parent, or guardian of the victim, by a person with whom the
victim shares a child in common, by a person who is cohabiting with, or has cohabited with the victim as a spouse,
parent, or guardian, or by a person similarly situated to a spouse, parent, or guardian of the victim. The term includes
all misdemeanors that have as an element the use or attempted use of physical force or the threatened use of a
deadly weapon (e.g., assault and battery), if the offense is committed by one of the defined parties.
Disclosure of the individual’s social security number is voluntary. The number may be used to verify the individual’s