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Washington County Concealed Handgun License ApplicationSherif f Pat GarrettConcealed Handgun Unit215 SW Adams Ave MS#32Hillsboro, OR 97123-3874503-846-2761www. WCS herif f -OR.co mNEW APPLICANTS AND TRANSFERS (FIRST TIME APPLICANTS TO WASHINGTON CO.) Save this application as a pdf to your computer before completing. Complete the application from your saved location. Send the application to CHLAPPS@co.washington.or.us as an attachment. Schedule your appointment using the online calendar, choosing the correct appointment type. Questions? Call 503-846-2761. The CHL staff will gladly assist you.RENEWAL APPLICANTSFeesBefore September 25,2021As Of September 25,2021New ApplicantRenewalTransferTransfer with RenewalChange of Address and/orNameDuplicate Cards 65.00 50.00 30.00 65.00 15.00 115.00 75.00 30.00 90.00 15.00 15.00 15.00RENEWALS: Washington County residents wanting to renew their concealed handgun license, must completethe renewal application and mail the application form with a check or money order of 50 made payable toWCSO. After September 25th the fee will increase to 75.00.

Washington County Concealed Handgun License ApplicationSherif f Pat GarrettConcealed Handgun Unit215 SW Adams Ave MS#32Hillsboro, OR 97123-3874503-846-2761www. WCS herif f -OR.co mAppointm ents are required for: New Applicants, Renewal s, Transfers and Transfer/ R ene w al s(f rom another Oregon Co). Please schedule your appointment using the “online scheduling calend ar ”on the Washington County Sherif f ’s Of f ice Concealed Handgun Licensing webpage.New Applicants: Please email/mail only the completed application. Do not send payment or supportingdocuments with the application. All new applicants are required to show citizenship documentation at the time ofappointment; see page 3Citizenship Documentation. New applicants must also provide two pieces of unexpiredidentif ication at time of appointment. One ID must bear a photograph of the applicant.NOTE: There is no f ee f or an address change / name change when done with a renewal.Application Type:New 115Renewal 75Address Change 15Name Change 15Full Legal Name:LastAll other names ever used:2.Date of Birth:Height:Suffix3.Expires:Weight:Age:Eye Color:mm/dd/yyyyResidential Address:Sex:Hair ColorMailing Address:Address:City: State:Zip Code: How long at this address?State of Birth: US State:Reinstatement 15MiddleState:Transf er & Renewal 90Duplicate 15First1.Drivers Lic #:Transf er Only 30Address:City: State:Zip Code:or Foreign Country:Race/Ethni city:List all states you lived in as an adult (18 years ) including military bases:Contact Phone Numbers: Home #:Cell #:Work #:Email Address: (kept confidential):Pleas e check if you would like to receive the Washington County Sheriff’s Office monthly newsletters and othercommunic ationSocial Security Number (Optional):Disclosure of your Social Security account number is voluntary. Solicitation of the number is authorized underORS 166.291. It will be used only as a means of identification.**Add ress Change/D upli cat e/Nam e change: Sign here:DATENEW APPLICANT S / RENEWAL S /TRANSF ER / REINST AT EME NT: PLEASE CONTINUE TO NEXT PAGE -------------

Qualifications:You are required to answer the following questions, to provide sufficient information to complete a full backgroun d chec k .Failure to answer any question will result in your application being denied as incomplete. Making a false statemen t in thisapplication may result in prosecution for a misdemean or and will result in an automatic denial of your application .TrueFalse I am at least 21 years of age.TrueFalseNot applicable I have been discharged f rom the jurisdiction of the juvenile court f or morethan f our years, if while I was a minor, I was f ound to be within the jurisdiction of the juvenile court f orhaving committed an act which, if committed by an adult, would constitute a f elony or a misdemeano rinvolving violence, as def ined in ORS 166.470.TrueFalse I have NEVER been convicted of a f elony. This includes being f ound guilty of a f elony byreason of insanity under ORS 161.295, in the State of Oregon or elsewhere. If f alse, were you grantedrelief f rom the f irearms prohibition?YesNoWhat State and Court:When:TrueFalse I have NOT been convicted of a misdemeano r within the last f our years f rom the date of thisapplication. This includes being f ound guilty of a misdemeanor by reason of insanity under ORS 161.295in the State of Oregon or elsewhere.TrueFalse There are no outstanding warrants f or my arrest AND I am not f ree on any f orm of pre- trialrelease including diversion. (DUII)TrueFalse I have NOT been committed to the Mental Health and Development al Disabilities ServicesDivision under ORS 426.130, nor have I been f ound mentally ill and been prohibited f rom possessing af irearm because of mental illness. For those previous criminal or mental health conditions that do applyto me, I have been granted relief f rom the disability under ORS 166.274 or 18 U.S.C.925(c). Proof ofrelief must be attached to this application.TrueFalse I am not presently subject to an order under ORS 426.133 prohibiting me f rom purchasing orpossessing a f irearm.TrueFalse I have completed a handgun saf ety class and I meet the requirements of ORS166.291(1)(B )(f ) (A) to (G) of competency with a handgun; New applicants must bring documentatio nto the appointment indicating that they have completed a handgun saf ety class. Any of the f ollowing areacceptable; Please see page 5 of this application f or additional inf ormation. Handgun Saf ety course certif icate including the NRA instructors Name and NRA ID number. A Hunter Saf ety class certif icate, with documentatio n indicating handgun saf ety was a component ofthe class. A handgun saf ety class taught by law enf orcement or a community college utilizing NRA instructors. Evidence of equivalent experienc e with a handgun through participation in organized shootingcompetition, security guard, investigators, reserve law enf orcement of f icers or military servicetraining. Supporting documents can include a score card, training certif icate, DD214 or militarytraining record.I understand I will be f ingerprinted (new applicants and transf ers) and photographed (all) applicants.1.) Have you ever been dishonorably discharged from the United States Armed Forces?YesNoIf so, When?2) Have you ever been convicted of an offense (including a violation or infraction) involving controlled substanc es ? Acontrolled substanc e is defined under ORS 475.005( 6). Exampl es include but are not limited to marijuan a, ecstasy,heroin, cocaine, LSD, peyote, or methamph etamin e. (Alcohol is not a controlled substance.)YesNoIf so, When and where?2

3) Have you ever been in a court-order ed diversion program related to controlled substanc e (not including alcohol) chargeincluding violations and infractions?YesNo4) Are you subject to any type of restraining or stalking order issued by any court?YesNo4a. If you are subject to a restraining or stalking order, please provide information about the order: WHEN andWHERE WAS THE ORDER ISSUED?5.) Have you ever been required to register as a sex offender in any state?YesNoYesNo5a. If you answer ed Yes, what state required you to register?5b. Is the requirement to register as a sex offender still in effect?Please explainCitizenshi p Docum entati on: All new and transfer applicants must provide documentation of citizenship. Renewal applicants whom have not previousl y provided documentati on must do so at thetime of their renewal appointment.Note: ONLY ORIGINAL DOCUMENTS WILL BE ACCEPTED AS PROOF OF CITIZENSHIP (BIRTH CERTIFICATESMUST BE ISSUED BY THE RECORDS OF VITAL STATISTICS OR INDICATE THAT THE BIRTH WAS REGISTEREDWITH THE STATE. Note; most hospital certificates do not meet this requirement and passports must beunexpired).I am a citizen of the United States and I am providing the following documentation as proof ofcitizenship. Select One:U.S. Birth Certificate (indicating birth was registered with the state).VALID U.S. PassportFFS240 (Military Service Foreign Birth)NaturalizedorI am a legal resident alien who can document continuous residency in Washington County f or at least sixmonths; I have declared in writing to the Immigratio n and Naturalizatio n Service, my intention to become acitizen and I can present proof of receipt (the N-300 or N-400 f orm) to the Sherif f at the time of this application.N-300 FormN-400 FormI will be eligible to apply for citizenship on:All new and transfer applicants must provide documentation of citizenship. Renewal applicants whom have not previously provided documentation must do so at thetime oftheir renewal appointment.Note: ONLY ORIGINAL DOCUME NTS WILL BE ACCEP TE D AS PROOF OF CITIZENS HI P (BIRTHCERTIFI CATE S MUST BE ISSUED BY THE RECORDS OF VITAL STATISTI CS OR INDICATE THAT THEBIRTH WAS REGISTE RE D WITH THE STATE. Note; most hospital certificates do not meet thisrequirement and passports must be unexpired). Residency Requirements:Please select one of the following:I have a current Oregon driver’s license showing a residence address in Washingto n County.I am registered to vote in Washingto n County and I have a precinct memorand um card showing a residenceaddress in Washington County.I have documentat io n showing that I currently own or lease real property in Washingto n County.I have documentatio n showing that I f iled an Oregon tax return f or the most recent tax year, showing aresidence address in Washington County.List resident address es for the past 3 years if different than your current address:Address:City:StateZip Code:Address:City:StateZip Code:3

Out of State Applicants:True I currently live in a contiguous state and am applying as an out-of-state applicant.All out-of- state new applic ants and renewa ls must include a stateme nt of compelling busines s inter es t or other legitim atedemons tr ated need, which exhibits a correlation to Washington County .References for New Applicants Only:References are required for New Applicants Only. List two character references (may be relatives).1. Name:Address:City/State:Zip Code:2. Name:Address:City/State:Zip Code:All Applicants:Please read and initial each:I understand that I am required to provide the Sheriff’s Office with my current address. ORS 166.291( 3)( a).I understand that the fee for a change of address is 15.00. ORS 166.291( 5)( C).I understand that failure to update my address could be grounds for revocation of my Conceal ed HandgunLicense.Sworn Statement:Oregon law prohibits the issuance of a concealed handgun license to anyone with a f elony conviction, amisdemeano r conviction within the last f our years or anyone on pretrial release. Oregon law allows f or thedenial of a concealed handgun license if the Sherif f determines you are a danger, based upon a past patternof unlawf ul violence or threats of unlawf ul violence.CAUTI ON: Possession of a concealed handgun license does not authorize you to carry a f irearm in anyf ederal building, on secured airport areas or in any courthouse where the presiding judge has posted notice ofsuch prohibition. The Washingto n County Courthous e and court rooms located in the Law Enf orcementCenter are posted with this prohibition. If you are apprehend ed with a weapon on these premises yourconcealed handgun license may be seized and returned to the Sherif f , and you may be arrested and chargedwith a crime.Initial:I have read and understand this application. All inf ormation submitted is correct. I f urtherunderstand that making false statements on this application is a misdemeanor and I am subjectto prosecution and automatic denial or revocation. All payments are non-refundabl e.New Applicants: Sign at the time of appointment only.Signature of Applicant:Date Signed:Thank you for completing the application form.Please save and send as attachment to CHLapps@co.washington.or.us4