I understand that I am obligated to be complete and truthful in providing information on this application. I understand that all of the information disclosed by me in this application may be subject to public disclosure.

San Bernardino County Sheriff CCW Application
 
Last  First  Middle

If Applicable, Maiden Name or Other Name(s) Used
Last  First  Middle
Last  First  Middle
Date of Birth   Social Security No.   (No Dashes)
   

Number  Restrictions

Number Street
City  State  Zip
   
Appearance   
Height (in inches)  Weight  
Eye Color  Hair Color  Gender (M or F)
Day  Eve
Number  Street
City  State  Zip
Spouse Info
Last  First  Middle
Number  Street
City  State  Zip
Number  Street
City  State  Zip
   
 
Initial Application  Renewal Application
   

Do you now have, or have you ever had, a license to carry a concealed weapon (CCW)? If yes, please enter the issuing agency name, issue date and CCW license number.

Yes
Issuing Agency
Issue Date
CCW No.
   
Denied CCW

Have you ever applied for and been denied a CCW license? If yes, please enter the agency name, date, and the reason for denial. 
Yes
Agency Name
Date

   

Have you ever held and subsequently renounced your United States citizenship? If yes, please explain.
Yes
   
 

If you served with the Armed Forces, were you ever convicted of any charges or was your discharge other than honorable? If yes, please explain.

Yes
   
Lawsuit

Are you now, or have you been, a party to a lawsuit in the last five years? If yes, please explain.

Yes
   
Restraining Order Are you now, or have you been, subject to a restraining order(s) from any court? If yes, please explain.
Yes
   
Probation

Are you on probation or parole from any state for conviction of any offense, including traffic? If yes, please explain.

Yes
   
Traffic Violations

List all traffic violations (moving violations only) and motor vehicle accidents you have had in the last five years.
Date  Citation Number   
Type of Violation  Agency
Date  Citation Number
Type of Violation  Agency
Date  Citation Number
Type of Violation  Agency
Date  Citation Number
Type of Violation  Agency
Date  Citation Number
Type of Violation  Agency
   
Criminal Offense

Have you ever been convicted of any criminal offense (civilian or military) in the U.S. or any other country? If yes, please explain including the date, agency, charges and disposition.

Yes
Withheld Information

Have you withheld any fact that might affect the decision to approve this license? If yes, please explain.

Yes
   
Previous Addresses   
Number  Street
City  State  Zip
Number  Street
City  State  Zip
Number  Street
City  State  Zip
Number  Street
City  State  Zip

Have you ever been in a mental institution, treated for mental illness, or been found not-guilty by reason of insanity? If yes, please explain.
Yes
   
 

Are you now, or have you ever been, addicted to a controlled substance or alcohol, or have you ever utilized an illegal controlled substance, or have you ever reported to a detoxification or drug treatment program. If yes, please explain.

Yes
   
Firearms Incidents 

Have you ever been involved in an incident involving firearms? If yes, please explain.

Yes
   
Domestic Violence 

Have you ever been involved in a domestic violence incident? If yes, please explain.

Yes
   
Records of Arrest

List any arrest or formal charges, with or without disposition, for any criminal offenses within the U.S. or any other country (civilian or military) 
Yes
   
   
Description of Weapons

List below the weapons you desire to carry if granted a CCW license. You may carry concealed only the weapon(s) which you list and describe herein, and only for the purpose indicated. Any misuse will cause an automatic revocation and possible arrest.  
Make  Model  Caliber
Serial Number
Make  Model  Caliber
Serial Number
Make  Model  Caliber
Serial Number  
   
 

Please only submit one application.  You should receive an email confirmation within a week of your submission.