"Ohio Peace Officer Training Commission		APPLICATION FOR A LICENSE TO CARRY A CONCEALED HANDGUN				1632
		Please Type or Print in Ink				1633

SECTION I.				1634
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 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.				1635

Last		First		Middle		1638
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Street	City	State	County	Zip		1642
............	............	............	...........	............		1643

Street	City	State	Zip		1645
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Date of Birth		Place of Birth		Sex		Race		Residence Telephone		1647
...../..../....		............		....		.....		(...).........		1648

(1)(a) Are you legally living in the United States?		.... YES		.... NO		1650
(b) 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		1651
(2) Are you at least twenty-one years of age?		.... YES		.... NO		1652
(3) Are you a fugitive from justice?		.... YES		.... NO		1653
(4) Are you under indictment for a felony, except for a conviction or guilty plea the records of which a court has ordered sealed or expunged, have you ever been convicted of or pleaded guilty to a felony, or, except for a delinquent child adjudication the records of which a court has ordered sealed or expunged, have you ever been adjudicated a delinquent child for committing an act that would be a felony if committed by an adult?		.... YES		.... NO		1654
(5) Are you under indictment for or otherwise charged with, or, except for a conviction or guilty plea the records of which a court has ordered sealed or expunged, 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, except for a delinquent child adjudication the records of which a court has ordered sealed or expunged, 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		1655
(6) Are you under indictment for or otherwise charged with, or, except for a conviction or guilty plea the records of which a court has ordered sealed or expunged, 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, except for a delinquent child adjudication the records of which a court has ordered sealed or expunged, 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		1656
(7) Are you under indictment for or otherwise charged with, or, except for a conviction or guilty plea the records of which a court has ordered sealed or expunged, have you been convicted of or pleaded guilty to within ten years of the date of this application, resisting arrest, or, except for a delinquent child adjudication the records of which a court has ordered sealed or expunged, 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		1657
(8)(a) Are you under indictment for or otherwise charged with assault or negligent assault?		.... YES		.... NO		1658
(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		1659
(c) Have Except for a conviction, guilty plea, or delinquent child adjudication the records of which a court has ordered sealed or expunged, have you ever been convicted of, pleaded guilty to, or adjudicated a delinquent child for assaulting a peace officer?		.... YES		.... NO		1660
(9)(a) Have you ever been adjudicated as a mental defective?		.... YES		.... NO		1661
(b) Have you ever been committed to a mental institution?		.... YES		.... NO		1662
(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		1663

Street	City	State	County	Zip		1674
..........	..........	..........	..........	..........		1675
Dates of residence at this address			........................			1676

Street	City	State	County	Zip		1678
..........	..........	..........	..........	..........		1679
Dates of residence at this address			........................			1680

Street	City	State	County	Zip		1682
..........	..........	..........	..........	..........		1683
Dates of residence at this address			........................			1684

Street	City	State	County	Zip		1686
..........	..........	..........	..........	..........		1687
Dates of residence at this address			........................			1688

	.......................		1716
	Signature of Applicant"		1717