Fill - Free fillable Weapons Carry License Application Cherokee County PDF form

Weapons Carry License Application

Cherokee County

NEW APPLICANT

If you have never had a Georgia Weapons Carry License or your License has been

expired more than 30 days, the following MUST BE PROVIDED:

Georgia Driver’s License or State-Issued ID (must be valid and must have your CURRENT

Cherokee County Address)

A completed Weapons Carry License Application

$78.25 in cash ($20.00 denominations or less), money order, or credit card (4% service fee)

RENEWAL

If your Georgia Weapons Carry License has not been revoked and is still current,

or has been expired no more than 30 days, the following MUST BE PROVIDED:

Georgia Driver’s License or State-Issued ID (must be valid and must have your CURRENT

Cherokee County Address)

Current Weapons Carry License

A completed Weapons Carry License Application

$30.00 in in cash ($20.00 denominations or less), money order, or credit card (4% service

fee). You may purchase a temporary license for $1.00

IF YOU HAVE A P.O. BOX ON YOUR DRIVER’S LICENSE

****If you have a P.O. Box on your Georgia Driver’s License or State-Issued ID, you will need

to bring proof of domicile in Cherokee County (example: utility statement, voter registration,

motor vehicle registration) NOT ACCEPTED: Bank statements, credit card statements or

anything that has your social security number on it.****

Please refer to the next page if you are a Non-U.S.

Citizen, Retired Law Enforcement, or 18-20 years old.

RETIRED LAW ENFORCEMENT

Retired law enforcement officers may receive a Georgia Weapons Carry License at NO COST provided

that, in addition to the other requirements, they can show that they served as law enforcement officers for

10 of the last 12 years prior to their retirement. The term “law enforcement officer” is defined in

O.C.G.A. §16-11-129(h) as “any peace officer who is employed by the United States government or by

the State of Georgia or any political subdivision thereof and who is required by the terms of his or her

employment, whether by election or appointment, to give his or her full time to the preservation of public

order or the protection of life and property or the prevention of crime. Such term shall include

conservation rangers.” Retired Law Enforcement documentation only waives the fee. All other documents

and requirements must be met.

NON-U.S. CITIZENS

In addition to the documents that are required for an application, non- U.S. citizens must provide

documentation that show that the applicant is an eligible immigrant or non-resident.

18-20 YEAR OLDS

Georgia Law now allows for persons who are younger than 21-years old to obtain a Georgia Weapons

Carry License in very limited circumstances. In order to qualify, the applicant must have completed Basic

Training in the Armed Forces of the United States AND be actively serving in the Armed Forces of the

United States or have been honorably discharged from service. To apply for this license all of the

following documents MUST BE PROVIDED:

Documentation which confirms that you have completed Basic Training and are on Active Duty OR that

you have been Honorably Discharged and all of the documentation listed under “New Applicant.”

DPS 445 (5/16)

APPLICATION FOR WEAPONS CARRY LICENSE

Applicant’s Name:____________________________________________________________________________

First Middle Last (or as registered with INS)

Maiden Name, Aliases & Names Previously Used: __________________________________________________

Date of Birth: ___/___/___ (Age if < 21:____ + attach proof of completed basic training or honorable discharge)

INS Alien/Admission No. _________________________

Sex: _______Race: _________ Height _________ Weight: _______ Hair Color:_________ Eye Color: ________

Place of Birth: _______________________________________________________________________________

City State, Province or District Country

Residence/Street Address: _____________________________________________________________________ _

City, State, Zip: ____________________________________________ County: ______________________

Mailing Address if different:____________________________________________________________________

Phone Numbers: Home (_______) _____________________Other (_____) __________________________

GA Military Base of non-resident who is active military __________________(attach copy of active duty orders)

1. Are you currently a United States Citizen? …………………………………………….……… Yes No

Have you ever renounced your U.S. citizenship? …………………………………………….. Yes No

If so, attach a copy of the reversal of renunciation.

► If you are not a U.S. Citizen:

 You must show proof of name/address/date of birth/place of birth/INS or ICE number/photo ID.

 Identify all countries of citizenship:

 Attach: (a) Documentation of your lawful presence in the United States, for example:

-As to Immigrant Aliens: Resident Alien card, Permanent Resident Card or Immigrant

Visa with Adit Stamp; OR

-As to Non-Immigrant Aliens: a Student Visa, Tourist Visa, Employment Authorization

Card, or valid Passport with Arrival/Departure Record;

and

(b) Proof of residency in the State of Georgia.

2. Are you a non-immigrant (temporarily admitted) alien? [See above] …………………………. Yes No

If yes, attach proof that you fall within an exemption establishing your eligibility.

_____________________ County, Georgia County Number ________________

CHEROKEE

DPS 445 (5/16)

3. Have you been convicted of or pled guilty to any offense or court-martial charge involving the

unlawful possession or use of a controlled substance or dangerous drug within the past five

years or served any portion of incarceration or probation for use or possession of a

controlled substance within the past five years?........................................................................... Yes No

If yes and the foregoing conviction was for a misdemeanor drug offense, have you also within the past

five years been convicted of, or served any portion of incarceration or probation in that time for a second

misdemeanor drug offense involving use or possession of a controlled substance, unlawful manufacture

or distribution of a controlled substance or dangerous drug, or of unlawful possession or shipping of a

firearm, or had a weapon carry license revoked within the last 3 years?...................................... Yes No

If pardoned and firearms rights restored, attach copy of pardon.

4. Have you ever been convicted of, or pled guilty to, any misdemeanor crime involving the use or

attempted use of physical force or threatened use of a deadly weapon towards (a) anyone as to whom at

the time of the offense you were a current or former spouse, parent or guardian or similarly situated to a

spouse, parent or guardian, (b) a person with whom you had a child in common, or (c) a person you lived

with or had lived with as a spouse, parent or guardian or similarly situated to a spouse, parent or guardian,

including but not limited to a girlfriend, boyfriend, step-child, foster child or ward ? …...…. Yes No

If pardoned and firearms rights restored, attach copy of pardon.

5. Have you ever been convicted of or pled guilty to any felony offense or any offense punishable

by a term of imprisonment over one year, including a conviction by a court-martial under the

Uniform Code of Military Justice for an offense which would constitute a felony?................... Yes No

If pardoned and firearms rights restored, attach copy of pardon.

6. Have you ever been convicted of or pled guilty to any offense arising out of the unlawful

manufacture or distribution of a controlled substance or dangerous drug? …………………… Yes No

If pardoned and firearms rights restored, attach copy of pardon.

7. Have you ever been convicted of or pled guilty to carrying a weapon without a weapons

carry license, or carrying a weapon or long gun in an unauthorized location?…………..…… Yes No

If so, have you served any portion of incarceration or probation for such firearms offense

in the past five years or had any other conviction or guilty plea within the past five years?... Yes No

Attach proof of the date your term of incarceration or probation ended, whichever is later (if any).

8. Are you under current indictment or information (formal charges) for a crime punishable by

imprisonment for a term exceeding one year?......................................................................... Yes No

9. Have you left any state or any foreign jurisdiction to avoid criminal prosecution, to avoid

testifying in any criminal proceeding, or knowing that charges are pending against you?........Yes No

10. Have you tested positive for drugs in the past year, admitted to having used drugs within the past

year, or been arrested more than once in the last five years with the last arrest having been in the

past year for any offense arising out of the unlawful possession, manufacturing, distribution or use

of a controlled substance or other dangerous drug?.………………………………………… Yes No

DPS 445 (5/16)

11. Do you use any controlled substance or illegal drug other than as prescribed by a licensed

physician, or have you done so within the past year, or regularly used any such drug within

the past five years?................................................................................................................. Yes No

12. Are you addicted to or have you lost self-control over any controlled substance or drug? … Yes No

13. Are you, or have you ever been, subject to any court order (including but not limited to restraining

orders, protective orders, peace bonds & good behavior bonds) restraining you from harassing,

stalking, threatening, engaging in communication with, or refraining in any manner from contact with

or coming in proximity to any current or former spouse, any person with whom you have a child in

common, or person with whom you live or lived while in a sexual relationship?.....................Yes No

If yes, attach a copy of the order and any later order terminating or superceding

the original order.

14. Have you ever been dishonorably discharged from the U.S. Armed Forces, or separated

from the U.S. Armed Forces under a dismissal adjudged by a general court-martial? ………Yes No

15. Have you ever been found by a civil or criminal court, board, commission or other lawful

authority, as a result of subnormal intelligence, incompetency, mental illness, condition or

disease, to be a danger to yourself or others, to lack the mental capacity to manage your own

affairs, or to be incompetent to stand trial, guilty but mentally ill, not guilty by reason of insanity

or not guilty for lack of mental responsibility? ………….…………………………………...Yes No

16. Have you been hospitalized as an inpatient in any mental hospital or alcohol or drug treatment

center within the past 5 years, or have you ever been ordered to receive inpatient or outpatient

treatment at any treatment facility, mental health center, hospital, sanitarium, clinic or program

for a mental condition, drug abuse, or alcohol abuse, by any court, board, or other authority in

any civil, criminal or administrative proceeding? (If yes, attach a copy of the order) …..…Yes No

17. Have you had a weapons carry license revoked by a judge of a probate court within the

past 3 years?………………………………………………………………………….……….Yes No

I do swear and affirm under penalty of false swearing or perjury that the foregoing

information is true and correct to the best of my knowledge and belief.

__________________________________

APPLICANT’S SIGNATURE

Sworn to and subscribed before me

This _____ day of _____________, 20____ FOR COURT USE ONLY:

___________________________________ On ___________________________ the applicant was:

Clerk of Probate Court _____ issued a firearms license _____denied a firearms license

__________________________________________________

Judge/Clerk, Probate Court

APPLICANT PRIVACY RIGHTS

NOTIFICATION SIGNATURE FORM

(Applicant Notification and Record Challenge)

Your fingerprints will be used to check the criminal history records of the FBI. You have the

opportunity to complete or challenge the accuracy of the information contained in the FBI

identification record. The procedure for obtaining a change, correction or updating an FBI

identification record is set forth in Title 28 Code of Federal Regulations 16.34.

Procedures for obtaining a copy of the FBI criminal history record are set forth in 28 CFR 16.30

– 16.33 or go to the FBI website at http://fbi.gov/about-us/cjis/background-checks.

By signing this document below, I hereby state that I have reviewed a copy of the

Noncriminal Justice Applicant’s Privacy Rights form.

______________________________________________________________________________

Signature Print Name Date

NON-CRIMINAL JUSTICE APPLICANT’S PRIVACY RIGHTS

As an applicant that is the subject of a Georgia only or a Georgia and Federal Bureau of Investigation

(FBI) national fingerprint/biometric-based criminal history record check for a non-criminal justice

purpose (such as an application for a job or license, immigration or naturalization, security clearance, or

adoption), you have certain rights which are discussed below.

• You must be provided written notification that your fingerprints/biometrics will be used to

check the criminal history records maintained by the Georgia Crime Information Center

(GCIC) and the FBI, when a federal record check is so authorized.

• If your fingerprints/biometrics are used to conduct a FBI national criminal history check, you

are provided a copy of the Privacy Act Statement that would normally appear on the FBI

fingerprint card.

• If you have a criminal history record, the agency making a determination of your suitability

for the job, license, or other benefit must provide you the opportunity to complete or

challenge the accuracy of the information in the record.

• The agency must advise you of the procedures for changing, correcting, or updating your

criminal history record as set forth in Title 28, Code of Federal Regulations (CFR), Section

16.34.

• If you have a Georgia or FBI criminal history record, you should be afforded a reasonable

amount of time to correct or complete the record (or decline to do so) before the agency

denies you the job, license or other benefit based on information in the criminal history

record.

• In the event an adverse employment or licensing decision is made, you must be informed of

all information pertinent to that decision to include the contents of the record and the effect

the record had upon the decision. Failure to provide all such information to the person

subject to the adverse decision shall be a misdemeanor [O.C.G.A. § 35-3-34(b) and §35-3-

35(b)].

You have the right to expect the agency receiving the results of the criminal history record check will use

it only for authorized purposes and will not retain or disseminate it in violation of state and/or federal

statute, regulation or executive order, or rule, procedure or standard established by the National Crime

Prevention and Privacy Compact Council.

If the employment/licensing agency policy permits, the agency may provide you with a copy of your

Georgia or FBI criminal history record for review and possible challenge. If agency policy does not

permit it to provide you a copy of the record, information regarding how to obtain a copy of your

Georgia, FBI or other state criminal history may be obtained at the GBI website

(http://gbi.georgia.gov/obtaining-criminal-history-record-information).

If you decide to challenge the accuracy or completeness of your Georgia or FBI criminal history record,

you should send your challenge to the agency that contributed the questioned information. Alternatively,

you may send your challenge directly to GCIC provided the disputed arrest occurred in Georgia.

Instructions to dispute the accuracy of your criminal history can be obtained at the GBI website

(http://gbi.georgia.gov/obtaining-criminal-history-record-information).

PRIVACY ACT STATEMENT

Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and

associated information is generally authorized under 28 U.S.C. 534. Depending on the

nature of your application, supplemental authorities include Federal statutes, State

statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal

regulations. Providing your fingerprints and associated information is voluntary;

however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security

clearances, may be predicated on fingerprint-based background checks. Your

fingerprints and associated information/biometrics may be provided to the employing,

investigating, or otherwise responsible agency, and/or the FBI for the purpose of

comparing your fingerprints to other fingerprints in the FBI’s Next Generation

Identification (NGI) system or its successor systems (including civil, criminal, and latent

fingerprint repositories) or other available records of the employing, investigating, or

otherwise responsible agency. The FBI may retain your fingerprints and associated

information/biometrics in NGI after the completion of this application and, while

retained, your fingerprints may continue to be compared against other fingerprints

submitted to or retained by NGI.

Routine Uses: During the processing of this application and for as long thereafter as your

fingerprints and associated information/biometrics are retained in NGI, your information

may be disclosed pursuant to your consent, and may be disclosed without your consent as

permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be

published at any time in the Federal Register, including the Routine Uses for the NGI

system and the FBI’s Blanket Routine Uses. Routine uses include, but are not limited to,

disclosures to: employing, governmental or authorized non-governmental agencies

responsible for employment, contracting, licensing, security clearances, and other

suitability determinations; local, state, tribal, or federal law enforcement agencies;

criminal justice agencies; and agencies responsible for national security or public safety.

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