FIREARMS PERMIT RENEWAL APPLICATION - California

1 BSIS BUREAU OF security & INVESTIGATIVE SERVICES LJ I I I I BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY GAVIN NEWSOM, GOVERNOR DEPARTMENT OF CONSUMER AFFAIRS BUREAU OF security AND INVESTIGATIVE SERVICES Box 989002, West Sacramento, CA 95798-9002 P (916) 322-4000 | P (800) 952-5210 | F (916) 575-7290 | FIREARMS PERMIT RENEWAL APPLICATION NOTE: Read Fee Amount Due under Instructions carefully to help ensure payment of correct fee amount. An APPLICATION received without full payment will not be processed and will be returned to the applicant.

2 IMPORTANT: Read all instructions. An incomplete or incorrect APPLICATION will delay processing. By law you are required to submit your RENEWAL APPLICATION at least 60 days prior to expiration of your current FIREARMS PERMIT . Also, if your FIREARMS PERMIT is expired, you are ineligible to renew and must apply for a new initial FIREARMS PERMIT , including completing the required training for an initial PERMIT . ARMED FORCES PRIORITY REQUESTS Check box if you have served, or are currently serving, in the Armed Forces. Disclosure is voluntary. If you check the box, submit proof of your military service ( DD-214, DD-256, V-MET record, military orders, military , etc.) with your APPLICATION . Check box if you are a spouse or domestic partner of an active duty member of the Armed Forces assigned to a California duty is voluntary.

3 If you check the box, submit the following documentation with your APPLICATION . (You may be asked to provide original documents.) Certificate of marriage or domestic partnership or other legal union with an active duty member of the Armed Forces who is assigned to a duty station in this state under official active duty military orders. Verification of current licensure as a private security guard or officer in another state, district, or territory of the THIS SECTION TO BE COMPLETED BY APPLICANT COMPLETE ELECTRONICALLY ON COMPUTER OR PRINT CLEARLY IF HANDWRITTEN Last Name: First Name: Middle Name: FIREARMS PERMIT No. FIREARMS PERMIT Exp. Date Address of Record (Street Address, City, State, and Zip Code): MANDATORY-(SEE INSTRUCTIONS) Confidential/Residence Address: (SEE INSTRUCTIONS) Check box if requesting to update your address(es) with the Bureau (SEE INSTRUCTIONS) Date of Birth (MM, DD, YYYY) SSN/ITIN: Telephone No.

4 : Email Address (optional): Provide the number and expiration date for the license(s) you hold that you currently have associated with your FIREARMS PERMIT or wish to have associated with your FIREARMS PERMIT . NOTE: You cannot associate a FIREARMS PERMIT with a Private Patrol Operator License organized as a corporation, or a Private Investigator or Alarm Company Operator License organized as a corporation or limited liability company. License Type License No. Exp. Date License Type License No. Exp. Date PI (Sole Owner/Partners Only) security guard PI (QM)1 PPO (Sole Owner/Partners Only) 1) Provide the number and expiration date of the license on which you serve as the qualified manager. PPO (QM**) Alarm Agent Alarm Company (Sole Owner/Partners Only) Alarm Company (QM) Revised October 2021 Page 1 of 10 Check if you are an ACTIVE DUTY PEACE OFFICER, as defined in Chapter , (commencing with section 830)

5 Of Title 3 of part 2 of the Penal Code, or a federal qualified law enforcement officer, as defined in section 926B of Title 18 of the United States Code. If you check box, See Instructions. IMPORTANT INFORMATION- READ CAREFULLY: I understand that a BSIS FIREARMS PERMIT authorizes me to carry an exposed ( non-concealed) loaded firearm only of the caliber(s) listed on my PERMIT card and only while performing the duties of the license associated with the PERMIT . I also understand that a BSIS PERMIT does not authorize me to carry a concealed loaded firearm. Lastly, I understand that if I am a private patrol operator or alarm company operator licensee; or registered security guard or alarm agent, or qualified manager for a private patrol operator or alarm company operator licensee, I can only wear or use an exposed firearm while on duty when I am in uniform.

6 Mandatory Disclosure Language Submission of the requested information is mandatory. The Bureau of security and Investigative Services (BSIS) ofthe Department of Consumer Affairs (Department) cannot process your FIREARMS PERMIT RENEWAL APPLICATION unless all requested information is provided. Per the Information Practices Act, the Chief of the BSIS is responsible for maintaining the information in this APPLICATION . You have the right to review the records maintained on you by the BSIS or Department unless the records are exempt from disclosure by section of the Civil Code. Your completed APPLICATION becomes the property of the BSIS and will be used by authorized personnel to determine your eligibility for a license, registration or PERMIT .

7 Information on your APPLICATION may be transferred to other governmental or law enforcement agencies, as permitted by law. Pursuant to the California Public Records Act (Gov. Code 6250 et seq.) and the Information Practices Act ( ), the names and addresses of persons possessing a license, certificate, PERMIT or registration maybe disclosed by the BSIS unless otherwise specifically exempt from disclosure under the law. The BSIS makes every effort to protect the exempt personal information you provide us. The information you provide, however, may be disclosed in response to a court or administrative order, a subpoena, or a search warrant. Pursuant to Business and Professions Code section 30, providing your social security number is mandatory andwill be used primarily for tax enforcement purposes and for compliance with any judgment or order for family supportin accordance with section 17520 of the Family Code.

8 Your social security number may also be used for verification of licensure or examination status for national examination where licensure is reciprocal with a requesting state. If you fail to provide your social security number, you will be reported to the Franchise Tax Board (FTB), which may assess a $100 penalty against you. Further, pursuant to section 30, subdivision (n) your social security number together with your name, date of birth, and license information may be shared with the Office of the Chancellor of the California Community Colleges. The State Board of Equalization (BOE) and the FTB may share taxpayer information with the BSIS. You are required to pay your state tax obligation.

9 This APPLICATION may be denied or your license may be suspended if the state tax obligation is not paid and your name appears on either the BOE or FTB certified list of top 500 tax delinquencies. For questions about this notice or access to your record, you may contact the BSIS by mail at: Bureau of security and Investigative Services, Attn: Public Records Liaison, Box 980550, Sacramento, CA 95798-0550, by phone at (800) 952-5210, or by e-mail at For questions about the Department s Privacy Policy, you may contact the Department of Consumer Affairs at 1625 North Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-5210 or by e-mail at I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF California THAT: I personally completed this APPLICATION ; To the best of my knowledge all statements on this APPLICATION are true and correct.

10 I have completed the training requirements ( range for each caliber, classroom and exam) to renew a BSIS FIREARMS PERMIT or am an active duty peace officer who has successfully completed FIREARMS qualification training; I am not presently subject to any State of California or Federal prohibition from owning or being in possession of a firearm; and With full knowledge that all statements herein are subject to investigation and that any false, dishonest, or incomplete answer to any question on the APPLICATION may be grounds for denial or subsequent revocation of my FIREARMS PERMIT and any other license(s) I hold or may subject me to criminal prosecution.