CCW application - Los Angeles County Sheriff's Department

State of California, Department of JusticeStandard Application for CCW LicensePublic Disclosure AdmonitionOfficial Use Only -Type of PermitRequested ( ) Standard ( ) Judge( ) Reserve Officer ( ) 90 DayI understand that I am obligated to be complete and truthful in providing information on this application. Iunderstand that all of the information disclosed by me in this application may be subject to publicdisclosure.Applicant SignatureDateWitness Signature / Badge NumberDateSection I - Applicant Personal InformationName:Last First MiddleIf Applicable,Maiden Name or Other Name(s) Used:City and Countyof Residence:Country ofCitizenship:Date of Birth:Place of Birth:CityCountystateHeight: Weight: Color Eyes:Color Hair:Section 2 - Applicant Clearance Questions1. Do you now have, or have you ever had a license to carry a concealed weapon (CCW)?No Yes (If yes, please indicate below. Use additional pages if necessary.)Issuing AgencyIssue DateCCW#2.Have you ever applied for and been denied a license to carry a concealed weapon?No Yes (If yes, give agency name, date and reason for denial.)-3-