SUPERIOR COURT OF THE STATE OF DELAWARE REFERENCE QUESTIONNAIRE APPLICANT’S NAME ____________________________ DATE OF BIRTH ____________ APPLICANT’S ADDRESS ___________________________________________________ Street _______________________________________________________________________ City County State Zip Code REFERENCE MAY NOT BE RELATED TO APPLICANT ATTENTION REFERENCE: The above individual has applied to the State of Delaware for a licens e to ca rry a co ncea led de adly weapon. The applicant is required to furnish five (5) references from respectable citizens of the county in which such applicant resides. Your background knowledge of this individual is essential to our investigation. The application cannot be approved without this com pleted que stionnaire. Please fill out this questionnaire com pletely by answering every question, to the best of your ability. If your answer requires an explanation, use the additional space provided. RETURN THE REFERENCE TO THE APPLICANT FOR FILING WITH THE COMPLETED APPLICATION. REFERENCE’S NAME _____________________________________________________ DAYTIME PHONE ____________________ CELL PHONE:____________________ REFERENCE’S ADDRESS ___________________________________________________ Street _______________________________________________________________________ City County State Zip Code 1. How long have you known the applicant? 2. Has the applicant ever exhibited a propensity for violence which may reasonably render applicant’s possession of a handgun a danger to applicant or other law abiding citizens? Yes No If yes, explain 3. Do you know of any reason why the applicant should not be given a license to carry a concealed deadly weapon? Yes No If yes, explain American LegalNet, Inc. www.FormsWorkflow.com 4. Are you aware of the reason why this applicant has applied for a license to carry a concealed deadly weapon? Yes No If yes, explain (Additional Space) I DO HEREBY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THE FOREGOING REFERENCE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF, AND I SO INDICATE BY SIGNING BELOW IN THE DESIGNATED SPACE. Signature Revised 09/06 American LegalNet, Inc. www.FormsWorkflow.com