WVSP44A
Revised07/2020
WESTVIRGINIASTATEPOLICE
APPLICATIONFORCONCEALEDPISTOL/REVOLVERLICENSE
(Thisapplicationmustbecompletedininkorbytypewriter)
TotheSheriffof___________________________County,I,thebelownamedapplicant,swear/affirm,underpenaltyoflaw, that
theinformationcontainedwithinthisapplicationistrueandcorrecttothebestofmyknowledge.
DATESUBMITTED:____/_____/_____APPLICATIONTYPE:☐Initial☐RenewalNoFee:______________________
NAME:_________________________________________________________________CONTACT#:_____________________________________
LastFirstMiddle
ADDRESS:______________________________________________________________________________________________________________
StreetCityStateZip
DOB:_______/________/_________SSN:_________‐_______‐___________PLACEOFBIRTH:_________________________________________
COUNTRYOFCITIZENSHIP:________________________________ALIEN/ADMISSION#:_______________________________(IfnotUScitizen)
HT:________Ft._________In.WT:_____________RACE:________________SEX:□M□FEYES:_____________HAIR:______________________
SCARS,MARKS,AND/ORTATTOOS(Descriptionandlocation):_____________________________________________________________________
________________________________________________________________________________________________________________________
Iamabonafideresidentof_____________________________county,WVandpresentthefollowingoriginal,validWVissuedphotoIDinsupport
ofthisassertion(PhotocopyofIDmustbeattachedtothisapplication):
☐WVDriver’sLicense#___________________☐WVNon‐Driver’sID#______________________☐Other(Describe)_________________
AnswereachofthefollowingquestionsbycheckingYESorNO:
QUESTION YES NO
1. Areyouunder21yearsofage?IfyesProvisionalApplicationform44Cmustbecompleted 
2. Areyouaddictedtoalcohol,acontrolledsubstanceordrug,orareyouanunlawfuluserthereof? 
3. Haveyoubeenconvictedofafelony? 
4. HaveyoubeenconvictedofanactofviolenceoranactofDomesticViolence? 
5. Areyouunderindictmentordoyouhaveanycriminalchargespendingagainstyou? 
6. Are you currently serving asentence of confinement, parole, probationorothercourtorderedsupervisionduetoa
chargeofdomesticviolenceasprovidedforin61‐2‐28oftheCodeofWestVirginia?

7. Areyouthe subjectof arestrainingorderasaresultofadomesticviolence actasdefinedin61‐2‐28oftheCodeof
WestVirginiaorsubjecttoaverifiedpetitionofdomesticviolenceorsubjecttoaprotectiveorderasprovidedforin
48‐2aoftheCodeofWestVirginia?

8. Haveyoueverbeenadjudicatedtobementallyincompetent? 
9. Doyouhavetwo(2)ormoreconvictionsforDUIrelatedoffenses? 
10. Inthelastthree(3)yearspriortothisapplication,haveyoubeeninaresidentialorcourtorderedtreatmentfacilityfor
alcoholismand/oralcohol/drugdetoxificationtreatment?

11. Ifyouareapplyingforalicensetocarryaconcealedhandgun,haveyouqualifiedundertheminimumrequirementsfor
thehandlingandfiringofahandgunassetforthin61‐7‐4oftheCodeofWestVirginia?IfYES,attachacopyofthe
certificate of completion to this application. The Sheriff will determine applicability of this section to Retired Law
EnforcementOfficersandRenewalApplicants.

12. Areyouphysicallyandmentallycompetenttocarryahandgun 
NOTE:Ifanyofquestions2‐10listedaboveareansweredYES,thenabriefletterofexplanationforeachquestionmustaccompanythisform.
I hereby authorize the Sheriff of _____________________________ County, to conduct an investigation into information containedinthis
application.Furthermore,Iunderstandthatthefalsificationofanyinformationcontainedwithinthisapplicationconstitutesfalseswearingand
isamisdemeanorpunishableundertheprovisionsof61‐5‐2oftheCodeofWestVirginia.
Applicant’sSignatureX_________________________________________________________________Date______________________________
NOT APPLICABLE
WVSP44A
Revised07/2020
WESTVIRGINIASTATEPOLICE
APPLICATIONFORCONCEALEDPISTOL/REVOLVERLICENSE
(Thisapplicationmustbecompletedininkorbytypewriter)
1. Theapplicantwillcompletetheform(inkortype)andaffixhis/hersignaturewhichmustbewitnessedbyanotary.
2. ThecompletedformwillbepresentedtotheSheriffoftheapplicant’sresidentcountyaccompaniedbytherequired$25.00
applicationfee.
3. TheSheriffwillconductaninvestigationrelativetotheinformationcontainedintheapplicationasrequiredbystatelaw.
AnyrequestforcriminalhistoryinformationfromtheStatePolicewillbemadeusingestablishedprotocol.
4. Uponcompletionof theinvestigation and if alicensetocarrya concealed pistol/revolverisapprovedandissued, the
applicant will pay to the Sheriff an additional $25.00 fee. The Sheriff will immediately forward to the State Police a
certifiedcopyoftheapprovedapplicationandwillforwardwithinthirty(30)daysthe$25.00feetothefollowingaddress:
Superintendent
WestVirginiaStatePolice
Attention:ConcealedWeaponRegistry
701JeffersonRoad
SouthCharleston,WV25309‐1698
NOTE:FeeswaivedforthefollowingofficialseffectiveJuly1,2013orJuly1,2020:
AnyjusticeoftheSupremeCourtofAppealsofWestVirginia;anycircuitjudge;anyretiredjusticeorretiredcircuitjudge
designatedseniorstatusbytheSupremeCourtofAppealsofWV;anyfamilycourtjudge;anymagistrate;anyprosecuting
attorney;anyassistantprosecutingattorney;anydulyappointedinvestigatoremployedbyaprosecutingattorney;orany
honorablydischargedmilitaryveteran.
NOTE:NoapplicationwillbeacceptedwithouttheNICSTransactionNumberlisted.
NOTE:Whenforwardingthe$25.00feetotheWestVirginiaStatePolice,theSheriffmustprovidethename,dateofbirth
anddateofapplicationapprovalforeach$25.00feeremitted.
ApplicantName:___________________________________________________________________________________
ApplicantDOB:______________________________Phonecontact:_______________________________________
Subscribed and sworn before me, in said County
and State, this the _________ day of
______________________________,
20_________.
Mycommissionexpires:______________________
Notarypublicsignature
SEAL:

Dateapplicationreceived:______/______/______
Receivedby:_______________________________
SHERIFFDEPARTMENTUSEONLY
THISBLOCKTOBECOMPLETEDONLYUPON
APPROVALOFAPPLICATIONBYSHERIFF
IIICheck□YES□NO
WVCRIMINALRECORDCHECK□YES□NO
STATEIDNo.______________________________
NICSCheck:□YES□NO
NICSTRANSACTIONNo.(NTN):___________________
NOTE:ApplicationwillbereturnedwithoutNTN#
I,_____________________________________,
Sheriff of _______________________ County, WV
certifythisdocumenttobeatrueandaccuratecopy
of the APPROVED APPLICATION for a Concealed
Pistol/Revolver Permit forthepersonidentified
hereinandhaveissuedapermitasrequiredbylaw.
________________________________________
Signature
______/______/____________/______/______

ApprovalDateExpirationDate