Application For Handgun License
State Form 36991 (R12/10-13)
Approved by State Board of Accounts, 2013
Instructions:
1.All questions must be answered.
2.THE INDIANA STATE POLICE IS NOT RESPONSIBLE FOR INCORRECT INFORMATION.
3.The applicant must visit his/her local law enforcement agency with payment to complete.

County of License:  
Name:
Last First Middle Suffix List all nicknames, married, maiden or other name changes
Address:
(line 2)
City: State:  ZIP code:
 
EMail:  
Date of Birth:   Sex: Height: Ft.  In.
Telephone number: Weight: Lbs.   
Build:
Scars, Marks, or Tattoos: 
Race: Hair Color: Eye Color:


















Employer/Business
Occupation:
Name:
Address:
City: State:   ZIP code:
 
Place of Birth
City: State:  
Additional Questions
Are you a U.S. Citizen? If non U.S. Citizen, enter your INS registration number:
I have been a resident of Indiana from To
Have you had a previous
Indiana handgun license?
Has your handgun license ever been
suspended/revoked?
Year: State Charges:
Have you ever been convicted of any misdemeanor violation that has not been expunged by a court? Including DUI?
If yes, list each charge (including year, location and state). Click 'Add Charge' after each.
   
Add Charge
Have you ever been convicted of any felony violation that has not been expunged by a court? Including DUI?
If yes, list each charge (including year, location and state). Click 'Add Charge' after each.
   
Add Charge
Have you ever been treated for psychiatric
health care or an emotional or mental illness?
  a. Year of recent treatment:
  b. Submit documentation/recommendation from treating mental health professional or treatment center.
Are you prohibited by court order from possessing a firearm?

Type of Handgun License








Mailing Address
Same as Permit Address:
Mailing Address:
(line 2)
City: State:   ZIP code:

WARNING

WARNING: Failure to disclose any and all criminal conviction information will result in the denial of your application and may result in criminal charges.

I affirm under the penalty for perjury as specified by IC 35-44-2-1 that the foregoing provided information is true to the best of my knowledge and belief. Any person giving false information or offering false evidence to obtain a firearms license may be deemed guilty of a felony and upon conviction may be punished by imprisonment up to three (3) years, to which may be added a fine of not more than $10,000.

Have you ever been convicted of ANY misdemeanor violation including DUI?

WARNING

WARNING: You may only apply for a new license within 365 days of current license expiration

WARNING

WARNING: You must submit all documentation/recommendation from your treating mental health professional or treatment center to:

Firearms Section
Attn: Staff Attorney
100 N. Senate Ave IGCN RM 302
Indianapolis, IN 46204-2259
WARNING

WARNING: I have not identified myself legally or otherwise by any other names except the names indicated here.