Fill and Sign the Reference Gun Permit Form

Detailed Character Reference in Support of Application for Gun Permit Full Name of Applicant ______________________________________________________ Full Name of Reference _____________________________________________________ Address ______________________________________________________________ Home Phone ______________________________________________________________ Cell Phone _____________________________ Date of Birth __________________________________________________________ Business Address ______________________________________________________ __________________________________________________________ Business Phone _____________________________ Name of Employer _____________________________ 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. ____________________________________________________________________________ ____________________________________________________________________________ ______________________________________________________________________ I have answered all questions above to the best of my knowledge, and I understand that any false statements made by me are punishable by a Class _____ misdemeanor pursuant to the laws of the state of _________________ (name of state) . ________________________________ (Signature of Character Reference) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ________________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: ___________________