CCW application - Los Angeles County Sheriff's Department

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State of California, Department of JusticeStandard Application for CCW LicenseSection 2- Applicant Clearance Questions -(continued)3. Have you ever held and subsequently renounced your United States citizenship?No Yes (If yes, explain):4. If you served with the Armed Forces, were you ever convicted of any charges or wasyour discharge other than honorable? NoYes(If yes, explain):5. Are you now, or have you been, a party to a lawsuit in the last rive years?No Yes (If yes, explain):6.Are you now, or have you been, under a restraining order(s) from any court?NoYes(If yes, explain):7.Are you on probation or parole from any state for conviction of any offense includingtraffic? No Yes (If yes, explain):-4-
State of California, Department of JusticeStandard Application for CCW LicenseSection 2-Applicant Clearance Questions -(continued)8. List all traffic violations (moving violations only) and motor vehicle accidents you have had in the lastfive years. (Use additional pages if necessary.)Violation / AccidentDate Agency / Citation #9. Have you ever been convicted for any criminal offense (civilian or military) in the U.S. or any othercountry?NoYes(If yes, explain including date, agency, charges, and disposition.)10. Have you withheld any fact that might affect the decision to approve this license?NoYes(If yes, explain):Section 3-Descriptions of Weapons:List below the weapons you desire to carry if granted a CCW. 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 automaticrevocation and possible arrest. (Use additional pages if necessary.)MakeModelCaliberSerial No.1.2.3.-5-
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CCW application - Los Angeles County Sheriff's Department

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