2006 Ohio Revised Code - [2923.12.10] 2923.1210.Form of application.

[§ 2923.12.10] § 2923.1210. Form of application.
 

The application for a license to carry a concealed handgun or for the renewal of a license of that nature that is to be used under section 2923.125 [2923.12.5] of the Revised Code shall conform substantially to the following form: 
 

"Ohio Peace Officer      APPLICATION FOR A LICENSE   
 

Training Commission      TO CARRY A CONCEALED HANDGUN   
   
Please Type or Print in Ink   

SECTION I. 
 

This application will not be processed unless all applicable questions have been answered and until all required supporting documents as described in division (B) or (F) of section 2923.125 [2923.12.5] of the Ohio Revised Code and, unless waived, a cashier's check, certified check, or money order in the amount of the applicable license fee or license renewal fee have been submitted. FEES ARE NONREFUNDABLE. 
 

SECTION II. 
 

Name: 
 

Last           First           Middle 
 

........          ........            ... 
 

Social Security Number:  ............... 
 

Current Residence: 
 

Street       City       State       County       Zip 
 

........      ........      ........        ........      ........ 
 

Mailing Address (If Different From Above): 
 

Street       City       State       Zip 
 

........      ........      ........      ........ 
 

Date of Birth   Place of Birth   Sex   Race      Residence   
 

     Telephone   
 

.../  .../  ...        .............      ....    .....   (  ...)       ......   
 

SECTION III. THE FOLLOWING QUESTIONS ARE TO BE ANSWERED YES OR NO 

(1) Have you been a resident of Ohio for at least forty-five days and have you been a resident for thirty days of the county with whose sheriff you are filing this application or of a county adjacent to that county?       ... YES    ... NO 

(2) Are you at least twenty-one years of age?       ... YES    ... NO 

(3) Are you a fugitive from justice?       ... YES    ... NO 

(4) Are you under indictment for a felony, have you ever been convicted of or pleaded guilty to a felony, or have you ever been adjudicated a delinquent child for committing an act that would be a felony if committed by an adult?       ... YES    ... NO 

(5) Are you under indictment for or otherwise charged with, or have you ever been convicted of or pleaded guilty to, an offense under Chapter 2925., 3719., or 4729. of the Ohio Revised Code that involves the illegal possession, use, sale, administration, or distribution of or trafficking in a drug of abuse, or have you ever been adjudicated a delinquent child for committing an act that would be an offense of that nature if committed by an adult?       ... YES    ... NO 

(6) Are you under indictment for or otherwise charged with, or have you been convicted of or pleaded guilty to within three years of the date of this application, a misdemeanor that is an offense of violence or the offense of possessing a revoked or suspended  

concealed handgun license, or have you been adjudicated a delinquent child within three years of the date of this application for committing an act that would be a misdemeanor of that nature if committed by an adult?       ... YES    ... NO 

(7) Are you under indictment for or otherwise charged with, or have you been convicted of or pleaded guilty to within ten years of the date of this application, resisting arrest, or have you been adjudicated a delinquent child for committing, within ten years of the date of this application an act that if committed by an adult would be the offense of resisting arrest?       ... YES    ... NO 

(8) (a) Are you under indictment for or otherwise charged with assault or negligent assault?       ... YES    ... NO 

(b) Have you been convicted of, pleaded guilty to, or adjudicated a delinquent child two or more times for committing assault or negligent assault within five years of the date of this application?       ... YES    ... NO 

(c) Have you ever been convicted of, pleaded guilty to, or adjudicated a delinquent child for assaulting a peace officer?       ... YES    ... NO 

(9) (a) Have you ever been adjudicated as a mental defective?       ... YES    ... NO 

(b) Have you ever been committed to a mental institution?       ... YES    ... NO 

(10) Are you currently subject to a civil protection order, a temporary protection order, or a protection order issued by a court of another state?       ... YES    ... NO 
 

SECTION IV. YOU MUST COMPLETE THIS SECTION OF THE APPLICATION BY PROVIDING, TO THE BEST OF YOUR KNOWLEDGE, THE ADDRESS OF EACH PLACE OF RESIDENCE AT WHICH YOU RESIDED AT ANY TIME AFTER YOU ATTAINED EIGHTEEN YEARS OF AGE AND UNTIL YOU COMMENCED YOUR RESIDENCE AT THE LOCATION IDENTIFIED IN SECTION II OF THIS FORM, AND THE DATES OF RESIDENCE AT EACH OF THOSE ADDRESSES. IF YOU NEED MORE SPACE, COMPLETE AN ADDITIONAL SHEET WITH THE relevant INFORMATION, ATTACH IT TO THE APPLICATION, AND NOTE THE ATTACHMENT AT THE END OF THIS SECTION. 
 

Residence 1: 
 

Street       City       State       County       Zip 
 

........      ........      ........        ........      ........ 
 

Dates of residence at this address       .................... 
 

Residence 2: 
 

Street       City       State       County       Zip 
 

........      ........      ........        ........      ........ 
 

Dates of residence at this address       .................... 
 

Residence 3: 
 

Street       City       State       County       Zip 
 

........      ........      ........        ........      ........ 
 

Dates of residence at this address       .................... 
 

Residence 4: 
 

Street       City       State       County       Zip 
 

........      ........      ........        ........      ........ 
 

Dates of residence at this address       .................... 
 

SECTION V. 
 

AN APPLICANT WHO KNOWINGLY GIVES A FALSE ANSWER TO ANY QUESTION OR SUBMITS FALSE INFORMATION ON, OR A FALSE DOCUMENT WITH THE APPLICATION MAY BE PROSECUTED FOR FALSIFICATION TO OBTAIN A CONCEALED HANDGUN LICENSE, A FELONY OF THE FOURTH DEGREE, IN VIOLATION OF SECTION 2921.13 OF THE OHIO REVISED CODE. 

(1) I have been furnished, and have read, the pamphlet that explains the Ohio firearms laws, that provides instruction in dispute resolution and explains the Ohio laws related to that matter, and that provides information regarding all aspects of the use of deadly force with a firearm, and I am knowledgeable of the provisions of those laws and of the information on those matters. 

(2) I desire a legal means to carry a concealed handgun for defense of myself or a member of my family while engaged in lawful activity. 

(3) I have never been convicted of or pleaded guilty to a crime of violence in the state of Ohio or elsewhere. I am of sound mind. I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I understand that if I knowingly make any false statements herein I am subject to penalties prescribed by law. I authorize the sheriff or the sheriff's designee to inspect only those records or documents relevant to information required for this application. 

(4) The information contained in this application and all attached documents are true and correct to the best of my knowledge. 

      .................... 

     Signature of Applicant" 

HISTORY: 150 v H 12, § 1, eff. 4-8-04.
 

See the provisions of § 10 of H.B. 12 (150 v  - ) following RC § 2923.12.