INSTRUCTIONS NEW APPLICATIONS FOR A LICENSE TO CARRY A CONCEALED DEADLY WEAPON RETIRED DELAWARE POLICE OFFICER In order for your application for a License to Carry A Concealed Deadly Weapon to be processed the following steps must be completed: 1) Applications may be filed at any time, but must be filed in the County you reside. You must file the original set and a complete copy of all the documents. You may hand deliver your application, or, if all the requirements are met, you may mail your application as follows: New Castle County Special Investigations Unit, 5th Floor Delaware Department of Justice 820 N. French Street Wilmington, DE 19801 Kent County Kent County Prothonotary 38 The Green Dover, DE 19901 Sussex County Sussex County Prothonotary 1 The Circle, Suite 2 Georgetown, DE 19947 2) Include the statutory filing fee of $65.00 payable to the Prothonotary, two (2) 1½ " x 1½" color passport-style photographs of the applicant, taken within the six month period immediately preceding the filing of the application. 3) You must request a letter from the Chief of your agency verifying that you are in good standing with the law enforcement agency from which you retired. (see attached) 4) A Psychiatric Waiver must be filed with our application. (see attached) If you have any questions, please contact the Prothonotary’s Office. New Castle County Kent County Sussex County 302-255-0556 302-739-3184 302-854-6959 Revised 5/2010 American LegalNet, Inc. www.FormsWorkFlow.com Retired Delaware Police Office PSYCHIATRIC WAIVER I, Name affirm that I have not been committed to a psychiatric facility since the date of my retirement on . Date Signature Date American LegalNet, Inc. www.FormsWorkFlow.com Joseph R. Biden, III Attorney General State of Delaware 820 N. French Street, 8th Floor Wilmington, DE 19801 Dear Mr. Biden: Retired Delaware Officer is applying for a license to carry a concealed deadly weapon. Officer retired from on agency after date years of service. According to the provisions of Del. Code, Title 11, Chapter 5, § 1441, the following procedures have been completed: This officer has applied for this license within 90 days of his/her retirement. This officer has applied for this license more than 90 days, but within 20 years of his/her retirement and: 1) the retired officer’s criminal record has been reviewed and he/she has not been convicted of any crime greater than a violation since the date of his/her retirement and; 2) the retired office has no record of being committed to a psychiatric facility since the date of his/her retirement. He/She has forwarded a signed waiver stating he/she has not been committed to a psychiatric facility since the date of his/her retirement. Based upon this review, I feel he/she is currently a retired police officer in good standing and is qualified to carry a concealed deadly weapon under the provisions of the law. Sincerely, Signature Title: American LegalNet, Inc. www.FormsWorkFlow.com _ SUPERIOR COURT OF THE STATE OF DELAWARE APPLICATION FOR A LICENSE TO CARRY A CONCEALED DEADLY WEAPON Please file original and one (1) copy of all documents, together with the filing fee. Also attach two (2) current 1.5 x 1.5 color passport-style photographs. CCDW License No. New County in which you are applying New Castle 9 9 Renewal 9 Retired Police Officer 9 Kent 9 Sussex 9 Full Name(Last, First, Middle, Suffix) Address (Street, City, State, Zip) Home Phone No. Cell Phone No. Driver’s License or State ID # Social Security No. Date of Birth Sex US Citizen Yes Place of Birth No (City,State) Height Weight Eye Color Occupation Hair Color Employer’s Phone No. Name of Employer Address of Employer/Place of Business (Street, City, State, Zip) Reason for Application (Be VERY specific) Do you hold a permit in another state? Yes 9 No 9 If yes, which State? Have you ever been denied a permit? Yes 9 No 9 If yes, which State? Have you ever been convicted of any alcohol related offense? Yes 9 No 9 If yes, list date(s), place(s) offense(s) and sentence(s) Have you ever been convicted in this State or elsewhere of a felony or a crime of violence involving physical injury to another, whether or not armed with or having in your possession any weapon during the commission of such felony or crime of violence? Yes 9 No 9 Have you ever been committed for a mental disorder to any hospital, mental institution, or sanitarium? Yes 9 No 9 If yes, do you possess a certificate of a licensed medical doctor or psychiatrist that you no longer suffer from a mental disorder which interferes or handicaps you from handling deadly weapons? Yes 9 No 9 (If yes, attach certificate) Have you ever been convicted for the unlawful use, possession, or sale of a narcotic, dangerous drug, or central nervous system depressant or stimulant? Yes 9 No 9 Have you ever been, as a juvenile, adjudicated as delinquent for conduct which, if committed by an adult, would constitute a felony? Yes 9 No 9 (A response to the question is not required if you have reached your 25th birthday.) IF ADDITIONAL SPACE IS NEEDED, ATTACH A SEPARATE SHEET American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION AND AFFIRMATION OF APPLICANT I , Applicant, respectfully state that I am desirous of being licensed to carry a concealed deadly weapon, for the protection of my person or property, or both, and for the particularized need stated in this application. I DO HEREBY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THE FOREGOING APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF; AND I SO INDICATE BY SIGNING BELOW IN THE DESIGNATED SPACE. I HAVE FULFILLED ALL REQUIREMENTS OF THIS APPLICATION AS INSTRUCTED. I AGREE TO SUPPLY ANY ADDITIONAL INFORMATION NEEDED IN CONNECTION WITH THIS APPLICATION. ANY FALSE INFORMATION WILL BE SUFFICIENT GROUNDS FOR DENIAL OF THIS APPLICATION. Wherefore, Applicant prays that the Superior Court issue a license pursuant to 11 Del. Code § 1441. Signature of Applicant Date SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF A.D., Notary Public Photograph of Applicant (1.5” x 1.5” square) Attach two photos FOR OFFICIAL USE ONLY Sent to DOJ (Date) Sent to Judge (Date) Investigator Recommendation Approved Denied Unrestricted Restricted Remarks Superior Court Approved Denied Unrestricted Restricted Remarks Reviewer Signature Judge’s Signature Date Attorney General Recommendation Approved Denied Unrestricted Restricted Remarks CCDW Permit No. SBI No. AG Signature Date Mailed American LegalNet, Inc. www.FormsWorkFlow.com