SKM_C450i24080210321









            





      



             













              

              

         

           

      



   



               

             Must

  

  

           

   

            

      









             

             











     





 

 



        







 

 

          



  

           

    



 















 



 

 

 

INSTRUCTIONS

 



 



 





 





WVSP44A

Revised05/2024

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:_______/________/_________ 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?IfYES,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.

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. Upo

n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a

pplicationandwillforwardwithinthirty(30)daysthe$25.00feetothefollowingadd

ress:

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tobeatrue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