My Concealed Weapon Registration Form

Full name: Jordan Harris



Date of birth: 10-16-92
Address: (blank)
Sex: Male
Race: African American with Hispanic Heritage

Current House Location: (Blank)
Current Job: None
Weapon knowledge: Basic Hunting Knowledge with course in weapon safety.
Remarks (such as tattoos, scars, etc.): None
What type of firearm do you intend to have: Handgun
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Mark your answer with a 'Yes' or 'No'



Are you a U.S Citizen? (if no; where from?): Yes
Have you had a firearm license before?: No
Have you ever been convicted?: No
Have you ever been treated for psychiatric, emotional or mental illness?: No


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What would you do if you had to use the weapon in public: To defend my self as necessarily.

Why do you want a weapons license: Protection

Type of license((Depends on the license you get))

Hunting (only by permission by the local government. $140 state fee applies: []
Personal protection: [X]
Carrying a firearm in public: []
Dealer's personal protection permit: []
Hunting w/ targets: []
Retired police officer: []
Retired army officer: []