Fill and Sign the Character Reference Form

Affidavit of Character Reference in Connection with Gun or Pistol License Investigation of Applicant Last Name of Applicant First Name Initial Pistol License No. ______________________ ____________________ ______ ________________ Information About Person Giving Character Reference Last Name of Applicant First Name Initial ______________________ ____________________ ______ Address _____________________________________________ Home Phone ___________ Business Phone ________________ Cell Phone____________ Date of Birth ______________ Maiden Name (if applicable) __________________ Name of Employer _________________________________________________ Business Address of Employer ___________________________________________________ Please read and answer every question carefully. If you need more space, use the blank lines at the bottom and indicate the question number. 1. How long have you known the applicant? __________ 2. What is your relationship to the applicant? _______________________________ 3. Do you recommend, without reservation, the applicant for a pistol license? ______ 4. Do you know the applicant to be a responsible person? _________ 5. Do you have any knowledge of the applicant abusing alcoholic beverages? _________ 6. Do you have any knowledge of the applicant using illegal drugs? _________________ 7. Do you have any knowledge of any domestic problems involving the applicant? _______ 8. Do you have any knowledge of the applicant ever threatening anyone, or displaying a violent temper? _______ If yes, under what circumstance? ____________________________________________________________________________ ____________________________________________________________________________ 9. Do you have any knowledge of the applicant associating with known criminals? _______ If yes, explain. _____________________________________________________ ___________________________________________________________________ 10. Do you have any knowledge of the applicant ever owning any handguns? If yes, give details: ____________________________________________________________________________ ____________________________________________________________________________ 11. Do you have any knowledge of the applicant ever suffering from, treated or hospitalized for any mental illness, or mental breakdowns? If yes, give details: ________________________ __________________________________________________________________________ 12. Do you now or have you ever held a pistol license? ____ If yes where? __________________________________________________________________________ 13. Please include any additional comments you may have below. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ___________________________________ Printed Name & Signature of Affiant SWORN to and subscribed before me, this the _____ day of _____________, 20____. _____________________________ NOTARY PUBLIC My Commission Expires: ______________________