FILE NUMBER: APPLICATIONFORCONCEALED …

SP-248 (7-1-2016). FILE NUMBER: APPLICATION FOR CONCEALED HANDGUN PERMIT RESIDENT PERMIT. COMMONWEALTH OF VIRGINIA NONRESIDENT PERMIT. _____ VIRGINIA CODE SECTIONS AND 06 RENEWAL. SEE NOTICE 2 PAGE 3. 1. FULL LEGAL NAME (ATTACH A S EP ARATE LISTING OF ANY ADDITIONAL NAMES YOU MAY HAVE US ED OR BEEN KNOWN BY) 2. DATE OF BIRTH (YOU MUST BE AT LEAS T 21 YEARS OF AGE ). FIRST _____ MIDDLE _____ LAST_____ MONTH _____ DAY _____ YEAR _____. 3. RESIDENTIAL ADDRESS (ATTACH A S EP ARATE LISTING OF ALL ADDRES S ES WITHIN THE LAST 5 YEAR P ERIOD). STREET OR RURAL ROUTE _____ CITY _____ COUNTY _____ STATE _____ ZIP _____. MAILING ADDRESS (IF DIFFERENT) _____EMAIL (OPTIONAL)_____. 4. PHYSICAL FEATURES 5. SOCIAL SECURITY NUMBER (OPTIONAL). SEE NOTICE 1 ON PAGE 3. HEIGHT _____ WEIGHT _____ SEX _____ RACE _____ HAIR COLOR _____ EYE COLOR _____.

notice 1 disclosure of social s ecurity number this information is provided pursuant to the government data collection and dissemination practices act (§ 2.2-3800 et seq).

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