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BROWSE CHEROKEE COUNTY GOVERNMENT (NC) FORMS

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The Office of the Sheriff must follow specific guidelines when processing Handgun Purchase Permit applications. Due to
the nature of this process, outside agencies involved, as well as due diligence required, processing times may take a
couple of weeks.
Federal statute 18 U.S.C. § 922(b)(1), restricts a federally licensed firearms
dealer from selling handguns to a person under the age of 21. However, an individual 18 to 20 years of age could lawfully
purchase or receive a handgun from a source other than a federally licensed firearms dealer.)
STATE OF NORTH CAROLINA
APPLICATION FOR
PERMIT(S) TO PURCHASE A HANDGUN
NEW PERMIT
DUPLICATE N. C. G. S. §14-402 et seq.
Name of Applicant (Last, First, Middle, Maiden) Attach listing of all previous
addresses and all name changes including location and court file number (If Applicable)
Street Address
Date of Birth
Social Security Number
See Notification on page 2
Time at Present Address
Yrs: Months:
Email Address (Optional)
City, County and State of Birth
City St
Z
Zip Code
Driver’s License Number (State ID Number if no Driver’s License)
State
Mailing Address:
Military Status
Active Reserve
Discharged Retired N/A
Race
See below for code
Sex
Telephone Number
County of Residence
Eyes
Hair
Height
Weight
Other Physical Description
RACE CODES: AI-American Indian, A-Asian, B-Black, H-Native Hawaiian, P-Pacific Islander, W-White, L-Latino/Hispanic
APPLICATION
I, the undersigned applicant, hereby make application for a North Carolina Permit(s) to Purchase a Handgun and state that the
following information is correct to the best of my knowledge.
(Check Appropriate Boxes)
1. Are you lawfully in the United States? (1) Yes No
2.
Are you a citizen of the United States? Non US Citizens must complete the Supplementary Questions for Applicants
(2) Yes No
If No, provide your Alien Admission Number here:
3. Are you 18 years of age or older? (3) Yes No
4. Are you ineligible to own, possess, or receive a firearm under the provisions of state or federal law? (4) Yes No
5. Are you under indictment or has a finding of probable cause been entered against you for a pending felony charge? (5) Yes No
6. Have you been adjudicated guilty in any court of a felony? (6) Yes* No
* If Yes: Have your firearm rights been restored pursuant to N.C.G.S. § 14-415.4, or Yes No
have you received a pardon which allows you to possess firearms?
If Yes, attach documentation
7. Are you a fugitive from justice? (7) Yes No
8. Are you an unlawful user of or addicted to marijuana, or any depressant, stimulant, or narcotic drug, or any
other controlled substance as defined in 21 U.S.C. § 802? (8) Yes No
9. Have you ever been adjudicated mentally incompetent or been committed to a mental institution? (9) Yes No
10. Have you been discharged from the U.S. Armed Forces under dishonorable conditions? (10) Yes No
11. Have you ever renounced your U.S. citizenship? (11) Yes No
12. Are you currently subject to a court order that restrains you from harassing, stalking, or threatening an intimate
partner or child of an intimate partner, or engaging in other conduct that would place an intimate partner in
reasonable fear of bodily injury to the partner or child? (12) Yes No
13. Are you currently under any type of probation or parole? (13) Yes No
SBI PTP – Revised 04/25/2016 Page 1
APPLICATION
Reason for the request for a Permit to Purchase a Handgun:
1. Protection of myself, home, business, property or family
2. Collecting
3. Target Shooting
4. Hunting
5. Number of permits requested
Applicant’s Signature
Date Application Signed
CAUTION: Federal law and State law on the purchase or possession of handguns and firearms may differ. If you are prohibited by
federal law from purchasing or possessing a handgun or a firearm, you may be prosecuted in federal court. A State permit is not a
defense to a federal prosecution.
SHERIFF USE ONLY
The following items were submitted – check applicable boxes:
1. Permit to Purchase Application ………………………..... 6. Date Issued Permit(s) __________________________________
2. Nonrefundable Permit Fee(s) Paid ………………………. 7. Date Denied Permit(s) __________________________________
($5.00 for each permit requested)
3. Copy of Government Issued Identification ……………… 8. NICS Transaction Number (NTN) _________________________
4. Proof of Residency ………………………………………... 9. Date Transactions Ran _________________________________
5. Signed Release for Mental Health Orders …………….... 10. Permit Number(s) _____________________________________
Signature of Sheriff: _____________________________________________________________________
Original – Sheriff / Copy – Applicant
__________________________________________________________________________________________________________________________________________________________________________________________________
SOCIAL SECURITY NUMBER: The disclosure of your social security number as a part of this Permit to Purchase application is voluntary. The purpose of
requesting the social security number is to assist in your identification and to help distinguish you from other persons with similar names. No Permit to Purchase
will be denied for failure to disclose a social security number.
SBI PTP – Revised 04/25/2016 Page 2
SUPPLEMENTARY QUESTIONS FOR APPLICANTS
FOR A PERMIT TO PURCHASE A HANDGUN
Prohibitions applicable to certain aliens. Federal law makes it unlawful for aliens who are illegally or unlawfully in
the United States to receive or possess firearms. In addition, subject to certain exemptions, aliens who are in a non-
immigrant status are prohibited from possessing or receiving firearms in the United States.
A non-immigrant alien is not subject to this prohibition if the alien falls into certain categories such as but not limited to:
1) Is in possession of a valid hunting license or permit lawfully issued in the United States; OR
2) Is an official representative of a foreign government who is accredited to the United States Government or his
or her government’s mission to an international organization having its headquarters in the United States; OR
3) Has received a waiver from the prohibition from the Attorney General of the United States. See 18 USC
922(y)(2) for additional exceptions.
In order to determine whether applicants who are not U.S. citizens are prohibited from possessing firearms under
Federal law, it is necessary to obtain answers to the following questions.
1)
Name:
2)
Are you a citizen of the United States?
. . . . . . . . . . . . . . . .
YES
NO
If your answer to Question 2 is “YES”, there is no need to answer Questions 3-8.
Go directly to the certification statement in Question 9.
SHERIFF: If the answer to Question 2 is “YES”, use “C” in the Citizenship (CTZ) field of the QNP transaction.
3)
What is your country of citizenship? List more than one if applicable.
4)
What is your place of birth? (City and Country)
. . . . . . . . . . . . . .
5)
What is your INS-issued alien number or admission number?
6)
Are you an alien illegally in the United States?
. . . . . . . . . . .
YES
NO
7)
Are you a non-immigrant alien?
. . . . . . . . . . . . . . . . . . . . . .
YES
NO
SHERIFF: If the answer to Question 7 is “YES”, proceed to Question 8a.
If the answer to Question 7 is “NO”, use “F” in the Citizenship (CTZ) field of the QNP transaction.
8a)
Do you fall within any of the exemptions to the non-immigrant alien prohibitions set forth in 18 USC 922(y)?
YES
NO
SHERIFF: If the answer to Question 8a is “YES”, proceed to Question 8b. If the answer to Question 8a is
“NO”, the NICS check cannot be initiated. As a non-immigrant, the subject is ineligible to
purchase, possess, or redeem a firearm if they do not meet one of the non-immigrant exemptions.
8b)
If you answered “YES” to Question 8a, under which exemption do you fall?
Please attach documentation to support your entitlement to the claimed exemption, if applicable.
SHERIFF: Validate the exemption item and indicate the exemption in the Exception Documentation (EXC)
field of the QNP transaction. Then place “F” in the Citizenship (CTZ) field of the QNP transaction.
9)
I certify that the above answers are true and correct.
Applicant’s Signature
Date
_________________________________________________________________________________________
Supplementary Questions SBI PTP – Revised 04/25/2016
Cherokee County Sheriff’s Office
577 Regal Street
Murphy, NC 28906
Phone 828-837-2589
Address History
Name:___________________________________________________________
BEGINNING WITH YOUR CURRENT ADDRESS LIST ALL ADDRESSES FOR THE
PAST 10 YEARS
Address
City/State/Zip/County
Years at Address
FROM
TO
Please put any additional information on the back side of this page
________________________________ ____________________________
SIGNATURE DATE
STATE OF NORTH CAROLINA
County
Name And Address Of Applicant Date Of Birth
State
Social Security No.
State Drivers License No. (State Identication No. if no drivers license)
RELEASE OF COURT ORDERS CONCERNING
MENTAL HEALTH AND CAPACITY
FOR PISTOL PURCHASE PERMIT
I hereby authorize and request any and all Clerks of Superior Court of North Carolina to inform the Sheriff of the county named above
whether or not the clerk’s les or records contain any court orders concerning my mental health or capacity. If so, I authorize the clerk
to reveal to the sheriff the court orders within any condential court les or records that the sheriff may reasonably require in order to
determine whether or not to issue a pistol purchase permit to me.
This Release may be treated as a motion in the cause for disclosure pursuant to G.S. 122C-54(d), which disclosure is necessary to
enable the sheriff to determine my qualication to purchase or possess a handgun. I stipulate that a clerk may reveal to the sheriff any
court orders pursuant to any specic or standing order entered in response to or anticipation of this motion.
I understand that further disclosure or redisclosure by the sheriff of any information disclosed to the sheriff pursuant to this Release is
prohibited without my further written consent unless otherwise provided for by state or federal law. I understand that I may revoke this
authorization at any time except to the extent that action has already been taken in reliance on this Release. Even without my express
revocation, this Release will expire upon the satisfaction of the request or one year from the date below, whichever occurs rst.
I authorize the sheriff to photocopy this Release after I sign it, and I authorize any clerk to whom a photocopy of this Release is presented
to rely on the photocopy as being as effective as the original.
NOTE TO CLERK:
This Release authorizes the disclosure of only court orders concerning the mental health or capacity of the applicant for a pistol
purchase permit pursuant to G.S. 14-404. Unless requested via a separate motion under G.S. 122C-54(d) and specically ordered by the court, the clerk
may not release any records or information from an involuntary commitment proceeding other than an actual court order in response to this Release.
Date
Date Signature Of Person Authorized To Administer Oaths
Title
Date Commission Expires
Signature Of Applicant
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
SEAL
G.S. 14-404(e1)
AOC-SP-917, New 12/15
© 2015 Administrative Ofce of the Courts
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Completed 21 January 2021

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