FORM 1 SP 248 Application For Concealed Handgun Permit Rev 7 2013
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SP-248 (7-1-2016) FILE NUMBER: ________________________________ RESIDENT PERMIT NONRESIDENT PERMIT RENEWAL APPLICATION FOR CONCEALED HANDGUN PERMIT COMMONWEALTH OF VIRGINIA VIRGINIA CODE SECTIONS 18.2-308.02 AND 06 1. FULL LEGAL NAME (ATTACH A S EP ARATE LISTING OF ANY ADDITIONAL NAMES YOU MAY HAVE US ED OR BEEN KNOWN BY) SEE NOTICE 2 PAGE 3 2. DATE OF BIRTH FIRST ___________________________ MIDDLE ______________________ LAST___________________________________ MONTH (YOU MUST BE AT LEAS T 21 YEARS OF AGE ) ______ DAY _____ YEAR ________ 3. RESIDENTIAL ADDRESS (ATTACH A S EP ARATE LISTING OF ALL ADDRES S ES WITHIN THE LAST 5 YEAR P ERIOD) STREET OR RURAL ROUTE ____________________________________ CITY ______________________________ COUNTY ____________________________ STATE _________ ZIP ____________ MAILING ADDRESS (IF DIFFERENT) ______________________________________________________________________EMAIL (OPTIONAL)_________________________________ 4. PHYSICAL FEATURES 5. SOCIAL SECURITY NUMBER (OPTIONAL) HEIGHT _____ WEIGHT ______ SEX _____ RACE _____ HAIR COLOR ________ SEE NOTICE 1 ON PAGE 3 EYE COLOR __________ SCARS, MARKS, TATTOOS, PECULIAR CHARACTERISTICS: ___________________________________________________________ 6. PLACE OF BIRTH COUNTRY OF CITIZENSHIP (YOU MUST BE A UNITED STATES CITIZEN OR HAVE LAWFUL PERMANENT RES IDENCE . NON-CITIZEN AP P LICANTS MUST P ROVIDE A VALID INS -IS S UED ALIEN REGISTRATION NUMBER .) (LOCALITY/STATE /NATION) UNITED STATES OTHER: __________________________ ALIEN REGISTRATION NUMBER:__________________________ _____________________________ 7. TELEPHONE NUMBER HOME___________________ OTHER __________________ 8. CHECK YES OR NO FOR EACH OF THE FOLLOWING QUESTIONS 1. HAVE YOU EVER BEEN CONVICTED OF A FELONY OFFENSE? (INCLUDE FELONY CONVICTIONS OF DRIVING UNDER THE INFLUENCE AND/OR ANY OFFENSE FOR WHICH YOU WERE CONVICTED AS A JUVENILE, WHICH WOULD HAVE BEEN A FELONY IF COMMITTED BY AN ADULT. IF YES, COMPLETE FORM 1 PART B PAGE 2. FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT . YES NO 2. HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OFFENSE WITHIN THE FIVE-YEAR PERIOD IMMEDIATELY PRECEDING THIS APPLICATION? (INCLUDE MISDEMEANOR CONVICTIONS OF DRIVING UNDER THE INFLUENCE. DO NOT INCLUDE TRAFFIC INFRACTIONS OR THOSE MISDEMEANORS SET FORTH IN TITLE 46.2 CODE OF VIRGINIA.) IF YES, COMPLETE FORM 1 PART B PAGE 2. FAILURE TO ACKNOWLEDGE A CONVICTION MAY BE CONSTRUED AS MAKING A MATERIALLY FALSE STATEMENT . YES NO B. HAVE YOU BEEN COMMITTED TO THE CUSTODY OF THE COMMISSIONER OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES? IF YES, COMPLETE FORM 2 PART A PAGE 2 ( SEE NOTICE 4 PAGE 3) YES NO C. HAVE YOU BEEN ACQUITTED BY REASON OF INSANITY, ADJUDICATED LEGALLY INCOMPETENT, MENTALLY INCAPACITATED OR ADJUDICATED AN INCAPACITATED PERSON BY A COURT OF VIRGINIA OR ANY OTHER COURT? IF YES, COMPLETE FORM 2 PART B PAGE 2. ( SEE NOTICE 4 PAGE 3) YES NO D. HAVE YOU BEEN INVOLUNTARILY ADMITTED TO A FACILITY OR ORDERED TO MANDATORY OUTPATIENT TREATMENT, OR WERE YOU THE SUBJECT OF A TEMPORARY DETENTION ORDER PURSUANT TO VA. CODE § 37.2-809 WHO LATER AGREED TO VOLUNTARY ADMISSION UNDER VA. CODE § 37.2-805? IF YES, COMPLETE FORM 2 PAGE 2 AS INDICATED BELOW. ( SEE NOTICE 4 PAGE 3) 1. COMPLETE PART C OF FORM 2 PAGE 2 IF INVOLUNTARILY ADMITTED 2. COMPLETE PART D OF FORM 2 PAGE 2 IF ORDERED TO MANDATORY OUTPATIENT TREATMENT 3. COMPLETE PART E OF FORM 2 PAGE 2 IF VOLUNTARILY ADMITTED SUBSEQUENT TO A TEMPORARY DETENTION ORDER HAVE YOU RECEIVED MENTAL HEALTH TREATMENT OR SUBSTANCE ABUSE TREATMENT IN A RESIDENTIAL SETTING WITHIN THE FIVE YEARS PRIOR TO THE DATE OF THIS APPLICATION? YES NO YES NO F. ARE YOU THE SUBJECT OF, OR NAMED AS A RESPONDENT IN A RESTRAINING ORDER OR A PROTECTIVE ORDER? AN ACTIVE RESTRAINING OR PROTECTIVE ORDER MAY BE AN AUTOMATIC DISQUALIFIER IN VIRGINIA. SEE VA. CODE § 18.2-308.1:4. YES NO G. ARE YOU ADDICTED TO, OR AN UNLAWFUL USER OR DISTRIBUTOR OF MARIJUANA OR ANY CONTROLLED SUBSTANCE? YES NO H. ARE YOU AN ALIEN NOT LAWFULLY ADMITTED FOR PERMANENT RESIDENCE IN THE UNITED STATES? YES NO I. HAVE YOU BEEN DISCHARGED FROM THE ARMED FORCES OF THE UNITED STATES UNDER DISHONORABLE CONDITIONS? YES NO J. ARE YOU A FUGITIVE FROM JUSTICE? YES NO K. DO YOU HAVE ANY CRIMINAL CHARGE PENDING? IF YES, COMPLETE FORM 1 PART A PAGE 2. YES NO A. E. FAILURE TO ACKNOWLEDGE A P ENDING CHARGE MAY BE CONSTRUED AS MAKING A MATERIALLY FALS E STATEMENT. L. HAVE YOU, WITHIN THE THREE-YEAR PERIOD IMMEDIATELY PRECEDING THE DATE OF THIS APPLICATION, EITHER 1) BEEN FOUND GUILTY OF ANY DRUG-RELATED CRIMINAL OFFENSE AS SET FORTH IN ARTICLE 1 (§ 18.2-247 ET SEQ.) OF CHAPTER 7 OF TITLE 18.2 OR OF A CRIMINAL OFFENSE FOR THE ILLEGAL POSSESSION OR DISTRIBUTION OF MARIJUANA OR ANY CONTROLLED SUBSTANCE UNDER THE LAWS OF VIRGINIA, ANY OTHER STATE, THE DISTRICT OF COLUMBIA, OR THE UNITED STATES OR ITS TERRITORIES; OR 2) BEEN CHARGED WITH ANY OFFENSE ENUMERATED IN THIS PARAGRAPH AND THE TRIAL COURT FOUND THE FACTS OF THE CASE WERE SUFFICIENT FOR A FINDING OF GUILT AND DISPOSED OF THE CASE PURSUANT TO § 18.2-251 OR SUBSTANTIALITY SIMILAR LAW OF VIRGINIA, ANY OTHER STATE, THE DISTRICT OF COLUMBIA, OR THE UNITED STATES OR ITS TERRITORIES? IF YES, COMPLETE FORM 1 PART A OR B PAGE 2. YES NO M. DO YOU CURRENTLY HAVE A VALID RESIDENT CONCEALED HANDGUN PERMIT ISSUED BY A VIRGINIA CIRCUIT COURT? IF YES, NAME OF THE CIRCUIT COURT WHICH ISSUED THE PERMIT: ________________________________________ EXPIRATION DATE YES NO 9. ______________ ATTACH A PHOTOCOPY OF THE DOCUMENTATION THAT DEMONSTRATES YOUR COMPETENCE WITH A HANDGUN (INITIAL PERMITS ONLY). I, THE UNDERS IGNED, AFFIRM THAT THE INFORMATION CONTAINED IN THIS AP P LICATION AND IN ANY ATTACHMENTS TO THIS DOCUMENT IS BOTH CORRECT AND COMP LETE TO THE BES T OF MY KNOWLEDGE . THE WILLFUL MAKING OF A FALS E S TATEMENT IN THIS AP P LICATION CONS TITUTES P ERJ URY AND IS P UNIS HABLE IN ACCORDANCE WITH §18.2-434 OF THE CODE OF VIRGINIA. I ALS O AFFIRM AND UNDERS TAND THAT THE IS S UANCE OF A CONCEALED HANDGUN P ERMIT DOES NOT NECES S ARILY ENTITLE ME , THE UNDERS IGNED, TO P OS S ES S , TRANS P ORT OR S ELL A FIREARM UNDER S TATE OR FEDERAL LAW. / MONTH / DAY APPLICANT’S SIGNATURE YEAR STATE OF ________________, CITY OR COUNTY OF_________________________________ TO WIT: ACKNOWLEDGED, SUBSCRIBED AND SWORN TO BEFORE ME ON / MONTH / DAY YEAR NOTARY PUBLIC COURT CLERK (RESIDENT PERMITS ONLY): MY COMMISSION EXPIRES REGISTRATION # FORM 1 PART A PENDING CHARGES (FOR ADDITIONAL PENDING CHARGES, USE A PIECE OF PLAIN PAPER AND ATTACH) DESCRIBE THE PENDING CRIMINAL CHARGE AGAINST YOU: DATE OF CHARGE: ___________________ CURRENT STATUS OF CHARGE: ________________________________________________________ COUNTY, CITY AND STATE OF CHARGE: _____________________________________ ___________________________________________________________________________ PART B CONVICTIONS (FOR ADDITIONAL CONVICTIONS, USE A PIECE OF PLAIN PAPER AND ATTACH) DESCRIBE THE CHARGE FOR WHICH YOU WERE CONVICTED: DATE OF CONVICTION:___________________ _______________________________________________________ COUNTY, CITY AND STATE OF CHARGE: __________________________________ HAVE YOU RECEIVED A PARDON OR RESTORATION OF RIGHTS THAT INCLUDES YOUR FIREARM RIGHTS? IF YES, ATTACH SUPPORTING DOCUMENTATION. YES NO HAVE YOU BEEN CONVICTED / ADJUDICATED OF AN OFFENSE AS A JUVENILE WHICH WOULD HAVE BEEN A FELONY IF COMMITTED BY AN ADULT? IF YES, HAVE YOU COMPLETED A TERM OF SERVICE OF NO LESS THAN TWO YEARS IN THE ARMED FORCES OF THE UNITED STATES? ATTACH SUPPORTING DOCUMENTATION. DID YOU RECEIVE AN HONORABLE DISCHARGE YES NO YES NO YES NO NOT APPLICABLE FORM 2 PART A COMMITMENTS TO THE COMMISSIONER OF HEALTH AND DEVELOPMENTAL SERVICES DATE OF COMMITMENT:_______________ NAME OF COURT WHICH ENTERED THE ORDER: DATE YOU WERE RELEASED FROM CUSTODY:__________________________________ _____________________________________________________________________ LOCATION OF COURT (INCLUDE STREET ADDRESS, CITY, COUNTY, AND STATE)_______________________________________________ HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT? YES NO IF YES, HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION? YES IF YES, ATTACH SUPPORTING DOCUMENTATION. NO PART B ADJUDICATION OF LEGAL INCOMPETENCE OR MENTAL INCAPACITATION DATE OF ADJUDICATION:________________ NAME OF COURT WHICH ENTERED THE ORDER:_______________________________ LOCATION OF COURT (INCLUDE STREET ADDRESS, CITY, COUNTY, AND STATE)_______________________________________________ HAS YOUR COMPETENCY OR CAPACITY HAS BEEN RESTORED BY A COURT? YES NO IF YES, HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION? YES NO IF YES, ATTACH SUPPORTING DOCUMENTATION. PART C INVOLUNTARY ADMISSIONS DATE INVOLUNTARILY ADMITTED: ________________________ DATE RELEASED FROM THIS ADMISSION:____________________ NAME OF COURT WHICH ENTERED THE ORDER: _____________________________________________________________________ LOCATION OF COURT (INCLUDE STREET ADDRESS, CITY, COUNTY, AND STATE) _______________________________________________ HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT? YES NO IF YES, HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION? YES IF YES, ATTACH SUPPORTING DOCUMENTATION. NO PART D MANDATORY OUTPATIENT TREATMENT DATE ORDERED TO MANDATORY OUTPATIENT TREATMENT: ____________________________________________________ DATE RELEASED FROM MANDATORY OUTPATIENT TREATMENT: ____________________________________________________ NAME OF COURT WHICH ENTERED THE ORDER: ____________________________________________________________________ LOCATION OF COURT (INCLUDE STREET ADDRESS, CITY, COUNTY, AND STATE)_______________________________________________ HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT? YES NO IF YES, HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION? YES IF YES, ATTACH SUPPORTING DOCUMENTATION. NO PART E VOLUNTARY ADMISSION SUBSEQUENT TO A TEMPORARY DETENTION ORDER DATE OF TEMPORARY DETENTION ORDER (TDO):_________________________________________________________________ AFTER BEING SUBJECT TO A TEMPORARY DETENTION ORDER (TDO), DID YOU SUBSEQUENTLY AGREE TO VOLUNTARY ADMISSION PURSUANT TO VA CODE §37.2-805? YES NO IF YES, NAME OF COURT WHICH ENTERED THE ORDER: ________________________________________ LOCATION OF COURT (INCLUDE STREET ADDRESS, CITY, COUNTY, AND STATE)________________________________________________ HAVE YOUR FIREARM RIGHTS BEEN RESTORED BY A COURT? YES NO IF YES, HAVE FIVE YEARS ELAPSED SINCE THE DATE OF RESTORATION? YES IF YES, ATTACH SUPPORTING DOCUMENTATION. 2 NO NOTICE 1 DISCLOSURE OF SOCIAL SECURITY NUMBER THIS INFORMATION IS PROVIDED PURSUANT TO THE GOVERNMENT DATA COLLECTION AND DISSEMINATION PRACTICES ACT (§ 2.2-3800 ET SEQ). VIRGINIA CODE § 2.2-3800 (C) (10) PROVIDES THAT AN AGENCY SHALL NOT COLLECT PERSONAL INFORMATION EXCEPT AS EXPLICITLY OR IMPLICITLY AUTHORIZED BY LAW. PURSUANT TO VIRGINIA CODE § 2.2-3803 (A), IT IS UNLAWFUL FOR AN AGENCY TO REQUIRE AN INDIVIDUAL TO DISCLOSE OR FURNISH HIS SOCIAL SECURITY NUMBER FOR ANY PURPOSE IN CONNECTION WITH ANY ACTIVITY, OR TO REFUSE ANY SERVICE, PRIVILEGE OR RIGHT TO AN INDIVIDUAL WHOLLY OR PARTLY BECAUSE THE INDIVIDUAL DOES NOT DISCLOSE SUCH NUMBER, UNLESS THE DISCLOSURE OR FURNISHING OF SUCH NUMBER IS SPECIFICALLY REQUIRED BY FEDERAL OR STATE LAW. THE CLERK OF COURT MAY WITHHOLD FROM PUBLIC DISCLOSURE THE SOCIAL SECURITY NUMBER CONTAINED IN A PERMIT APPLICATION IN RESPONSE TO A REQUEST TO INSPECT OR COPY ANY SUCH APPLICATION EXCEPT THAT THE SOCIAL SECURITY NUMBER SHALL NOT BE WITHHELD FROM ANY LAW-ENFORCEMENT OFFICER ACTING IN THE PERFORMANCE OF HIS OFFICIAL DUTIES. THE SOCIAL SECURITY NUMBER IS NOT MADE PART OF ANY PUBLIC RECORD BY THE DEPARTMENT OF STATE POLICE. NOTICE 2 WHERE TO APPLY COMPLETE AND NOTARIZED APPLICATIONS FOR RESIDENT PERMITS SHALL BE FORWARDED TO THE CIRCUIT COURT OF THE COUNTY OR CITY IN WHICH THE APPLICANT RESIDES. THE APPLICANT SHOULD CONSULT WITH THE COURT AUTHORITIES FOR INSTRUCTION AND GUIDANCE SPECIFIC TO HIS OR HER APPLICATION. COMPLETE AND NOTARIZED APPLICATIONS FOR NONRESIDENT PERMITS SHALL BE FORWARDED TO THE VIRGINIA STATE POLICE, FIREARMS TRANSACTION CENTER, POST OFFICE BOX 85608, RICHMOND, VIRGINIA, 23285-5608, ALONG WITH OTHER DOCUMENTATION AS AUTHORIZED BY STATUTE. SPECIFIC APPLICATION INFORMATION AND INSTRUCTION IS PROVIDED AT THE VIRGINIA STATE POLICE WEB SITE, WWW.VIRGINIATROOPER.ORG/, OR BY TELEPHONE (804) 674-2676. NOTICE 3 IF YOUR APPLICATION IS DENIED VIRGINIA RESIDENT APPLICANTS: (1) UPON DENIAL OF THE APPLICATION, THE CLERK SHALL PROVIDE THE PERSON WITH NOTICE, IN WRITING, OF HIS RIGHT TO AN ORE TENUS HEARING. UPON REQUEST OF THE APPLICANT MADE WITHIN 21 DAYS, THE COURT SHALL PLACE THE MATTER ON THE DOCKET. THE APPLICANT MAY BE REPRESENTED BY COUNSEL, BUT COUNSEL SHALL NOT BE APPOINTED, AND THE RULES OF EVIDENCE SHALL APPLY. THE FINAL ORDER OF THE COURT SHALL INCLUDE THE COURT'S FINDINGS OF FACT AND CONCLUSIONS OF LAW. (2) UPON DENIAL OF AN APPLICATION BY ANY PERSON WHO PREVIOUSLY HELD A CONCEALED HANDGUN PERMIT, THE CLERK SHALL PROVIDE THE PERSON WITH NOTICE, IN WRITING, OF HIS RIGHT TO AN ORE TENUS HEARING. UPON REQUEST OF THE APPLICANT MADE WITHIN 21 DAYS, THE COURT SHALL PLACE THE MATTER ON THE DOCKET. THE APPLICANT MAY BE REPRESENTED BY COUNSEL, BUT COUNSEL SHALL NOT BE APPOINTED, AND THE RULES OF EVIDENCE SHALL APPLY. THE FINAL ORDER OF THE COURT SHALL INCLUDE THE COURT'S FINDINGS OF FACT AND CONCLUSIONS OF LAW. (3) ANY PERSON DENIED A PERMIT TO CARRY A CONCEALED HANDGUN MAY PRESENT A PETITION FOR REVIEW TO THE COURT OF APPEALS. THE PETITION FOR REVIEW SHALL BE FILED WITHIN 60 DAYS OF THE EXPIRATION OF THE TIME FOR REQUESTING AN ORE TENUS HEARING,OR IF AN ORE TENUS HEARING IS REQUESTED, WITHIN 60 DAYS OF THE ENTRY OF THE FINAL ORDER OF THE CIRCUIT COURT FOLLOWING THE HEARING. THE PETITION SHALL BE ACCOMPANIED BY A COPY OF THE ORIGINAL PAPERS FILED IN THE CIRCUIT COURT, INCLUDING A COPY OF THE ORDER OF THE CIRCUIT COURT DENYING THE PERMIT. THE DECISION OF THE COURT OF APPEALS OR JUDGE SHALL BE FINAL. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IF THE DECISION TO DENY THE PERMIT IS REVERSED UPON APPEAL, TAXABLE COSTS INCURRED BY THE PERSON SHALL BE PAID BY THE COMMONWEALTH. [VIRGINIA CODE SECTION 18.2-308 .08] NONRESIDENT APPLICANTS: YOU MAY CONTACT THE VIRGINIA STATE POLICE, FIREARMS TRANSACTION CENTER (FTC), TO DISCUSS THE INELIGIBLE DETERMINATION AND/OR TO PROVIDE ADDITIONAL INFORMATION DEEMED PERTINENT TO THE FINAL DETERMINATION OF ELIGIBILITY AT (804)674-2676, OR WRITE TO THE FTC AT POST OFFICE BOX 85608, RICHMOND,VIRGINIA 23285-5608, OR EMAIL FIREARMS@VSP.STATE.VA.US. ANY PERSON DENIED A PERMIT FOR INACCURATE OR FALSE INFORMATION MAY NOT REAPPLY FOR A PERIOD OF 12 MONTHS FOLLOWING THE DATE OF FINAL DENIAL DETERMINATION BY THE SUPERINTENDENT. COMMITMENTS TO THE COMMISSIONER OF HEALTH AND DEVELOPMENTAL SERVICES NOTICE 4 ANY PERSON WHO HAS BEEN ACQUITTED BY REASON OF INSANITY PURSUANT TO §18.2-308.1:1 OR ANY SUBSTANTIALLY SIMILAR LAW OF ANY OTHER JURISDICTION, HAS BEEN ADJUDICATED LEGALLY INCOMPETENT OR MENTALLY INCAPACITATED PURSUANT TO §18.2-308.1:2 OR HAS BEEN INVOLUNTARILY ADMITTED TO A FACILITY OR ORDERED TO MANDATORY OUTPATIENT TREATMENT PURSUANT TO §18.2-308.1:3 OR HAS BEEN THE SUBJECT OF A TEMPORARY DETENTION ORDER UNDER §37.2-809 WHO SUBSEQUENTLY AGREED TO VOLUNTARY ADMISSION UNDER §37.2-805 IS PROHIBITED FROM PURCHASING, POSSESSING OR TRANSPORTING A FIREARM UNLESS HIS OR HER RIGHT TO PURCHASE, POSSESS, OR TRANSPORT A FIREARM HAS BEEN RESTORED BY THE AUTHORITY OF AN APPROPRIATE COURT. NOTICE 5 USE OF DEADLY OR LETHAL FORCE FOR THE PURPOSES OF UNDERSTANDING THE LAW RELATING TO THE USE OF DEADLY AND LETHAL FORCE, PLEASE REFERENCE THE VIRGINIA SUPREME COURT WEBSITE AT HTTP://WWW.COURTS.STATE.VA.US/COURTS/SCV/HOME.HTML. 3 CRIMINAL BACKGROUND INVESTIGATION (THIS SPACE FOR LAW ENFORCEMENT USE ONLY) YES NO PENDING CHARGES CONVICTIONS IF YES, SEE ATTACHMENT(S) / MONTH / DAY , OFFICER OR AGENCY DESIGNEE YEAR (THIS SPACE FOR COURT USE ONLY) RESIDENT PERMIT FILE NO. CIRCUIT COURT APPLICATION OF ON ________________ FOR A VIRGINIA RESIDENT CONCEALED HANDGUN PERMIT IS HEREBY: (DATE ) GRANTED DENIED (SEE EXPLANATION BELOW) THE PERMIT APPLICATION IS DENIED ON THE BASIS OF THE FOLLOWING: YOU ARE ENTITLED TO AN ORAL HEARING BEFORE THIS COURT. THE REQUEST FOR A HEARING MUST BE FILED WITH THIS COURT WITHIN TWENTY-ONE DAYS OF DENIAL OF YOUR APPLICATION. SEE NOTICE 3 PAGE 3 / MONTH / DAY , YEAR JUDGE CLERK (THIS SPACE FOR STATE POLICE USE ONLY) NONRESIDENT PERMIT FILE NO. APPLICATION OF FOR A VIRGINIA NONRESIDENT CONCEALED HANDGUN PERMIT IS HEREBY: GRANTED DENIED (SEE EXPLANATION BELOW) SEE NOTICE 3 PAGE 3 / MONTH / DAY , SUPERINTENDENT YEAR OR DESIGNEE 4
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