ELKO COUNTY SHERIFF'S OFFICE

775 W Silver St. Elko, NV 89801

CONCEALED CARRY WEAPONS PERMIT

1.FEES

ALL FEES ARE NON-REFUNDABLE(a) Initial application: The following feesare to besubmittedwithyour application:

$98.25 permit and investigation fee. This fee includesfingerprint processing.(b) Renewal application:

A $63.25 permit and investigation fee, which includes fingerprint processing. A $15.00 late fee isalsocharged if renewal isbeyond theexpiration date. If you fail to renew your permit within 120 days of the expiration of the permit, you will have to re-apply as anew applicant.

(cj Duplicate permit: A $15.00fee mustbe submitted fora duplicate permit in theeventof a change of address or ifa permit is lost,stolen or destroyed.

2 INSTRUCTIONS - COMPLETION OF YOUR APPLICATION

(a) Inquiries necessary to facilitate completion of your application should be directed to a servicerepresentativeat:Elko County Sheriffs Office

775 W. Silver Street

Elko, NV 89801Telephone: (775) 738-3421

(b) Takeyourcompleted application to the Elko County Sheriffs Office to have yourfingerprints, background, andphotograph taken.

(c) QUESTION 9. If you have been convicted of a felony asdescribed in Section 202.360, Nevada Revised Statutes, you must submit acertified copy ofthe document restoring your civil rights and a certified copy ofthe document that specifically restores your authority toown, possess, oruse a firearm. Ifyour civil rights and the specific authority to own, possess oruse a firearm have not been restored orifyou cannot provide proofof restoration of these rights, you arenot eligible for a Concealed Weapon Permit.

(d) Youmust demonstrate competence with a firearm by presenting a certificate ofcompletion that indicates youhave successfullycompleted a training course in theuse ofyour firearm. This training course must include instruction from a person who has beenapproved bya Sheriff in theState ofNevada, and isauthorized to instruct in the use offirearms andin dielaws ofNevada relating totheproper use of a firearm.

Your application must be processed withinoneyearof the date on which yourCCW class wascompleted.

3. PROCESSINGAllow upto 120 days for processing your completed application. Itcan take up to 120 days toobtain a records check back from theF.B.I.Incomplete applications cannot be processed.

4 ISSUANCE OF PERMITUpon approval ofyour application, your permit will be sent toyou by mail. Ifyour application is denied, you will receive written notificationsetting forth the reasons for the denial.

5.TERM OF PERMIT

Aconcealed weapon permit issued bytheElko County Sheriff tocarry a concealed weapon firearm expires 5 years from thedate of issuance.6.CHANGE OF ADDRESS; LOST, STOLEN OR DESTROYED PERMITS

(a) You must notify theSheriff in writing within 30days ifyour permanent address changes or ifyour permit is lost, stolen ordestroyed. Youwill be issued a duplicate permit if you:(1) Submit a written statement to theSheriff, signed under oath, stating thatyourpermit hasbeen lost, stolen or destroyed; and(2) Pay a nonrefundable fee of$ 15.00.

(b) Ifyousubsequently find or recover yourpermit after being issued a duplicate permit, youmust, within 10days:(1) Notify the Sheriff in writing; and(2) Return the duplicate permit to the Sheriff.(c) Ifyou fail to make theaforementioned notifications as indicated, you will besubject toa civil penalty of$25.00.

7. CARRYING OF PERMIT

NRS 202.3673 Permittee authorized to carry concealed firearm while on premises of public building; exceptions; penalty.(1) Except as otherwise provided in subsections 2 and 3, a permittee may carry a concealed firearm while he is on the premises of any

public building.(2) A permittee shall not carry a concealed firearm while he is on the premises of a public building that is located on the property of a

public airport.(3) A permittee shall not carry a concealed firearm while he is on the premises of:

(a) A public building that is located on the property ofa public school or the property of the University and Community CollegeSystem ofNevada, unless the permittee has obtained written permission to carry a concealed firearm while he is on thepremises ofthe public building pursuant to paragraph (c) of subsection 3 ofNRS 202.265.

(b) A public building that has a metal detector at each public entrance or a sign posted at each public entrance indicating that nofirearms are allowed in the building, unless the permittee is not prohibited from carry a concealed firearm while he is on thepremises of the public building pursuant to subsection 4.

(4) The provisions of paragraph (b) of subsection 3 do not prohibit:(a) A permittee who is a judge from carrying a concealed firearm in the courthouse or courtroom in which he presides or from

authorizing a permittee to carry a concealed firearm while in the courtroom of the judge and while traveling to and from thecourtroom of the judge.

(b) A permittee who is a prosecuting attorney of an agency or political subdivision ofthe United States or ofthis state fromcarrying a concealed firearm while he is on the premises of a public building.

(c) A permittee who is employed in the public building from carrying a concealed firearm while he is on the premises of thepublic building.

8. ELIGIBILITY

You are NOT eligible for a permit to carry a concealed weapon if any of the following applies to you:(a) Ifyou are not at least 21 years ofage.(b) Ifyou do not provide the required documentation to demonstrate competence with a firearm.(c) Ifyou have an outstanding warrant for your arrest.(d) Ifyou have been judicially declared incompetent or insane.(e) If you have been voluntarily or involuntarily admitted to a mental health facility during the immediately preceding 5 years.(f) Ifyou have habitually used intoxicating liquor or a controlled substance to the extent that your normal facilities are

impaired. It is presumed that you have so used intoxicating liquor or a controlled substance if, during the immediatelypreceding 5 years, you have been:

(1) Convicted of violating the provisions ofNRS 484.379 (driving under the influence); or(2) Committed for treatment pursuant to NRS 458.290 to 458.350, inclusive (substance abuse).

(g) Ifyou have been convicted ofa crime involving the use or threatened use offorce or violence punishable as a misdemeanorunder the laws of this or any other state, or a territory or possession of the United States at any time during the immediatelypreceding 3 years.

(h) Ifyou have been convicted of a felony in this state or under the laws ofany state, territory or possession ofthe UnitedStates,

(i) If you have been convicted of a crime involving domestic violence or stalking, or you are currently subject to a restrainingorder, injunction or other order for protection against violence,

(j) If you are currently on parole or probation from a conviction obtained in this state or in any other state or territory orpossession of the United States,

(k) If you have, within the immediately preceding 5 years, been subject to any requirements imposed by a court of this state orofany other state or territory or possession of the United States, as a condition to the court's:

(1) Withholding of the entry ofjudgment for your conviction ofa felony; or(2) Suspension ofyour sentence for the conviction ofa felony.

(1) If you have made a false statement on any application for a permit or for the renewal ofa permit.If, after reviewing the eligibility requirements, you determine that you are eligible to apply for a Concealed Firearms Permit, the following formsmust be completed, signed and submitted along with the appropriate fees:

1. A properly completed application form (both sides);2. A waiver form authorizing the release of information;3. A properly completed firearm certification form;4. A legal form of identification with a photo attached.5. If the applicant is a naturalized U.S. Citizen, applicant must provide a copy of their U.S. Passport or their Certificate of

Naturalization; and6. If applicant is not a citizen of the United States, applicant must provide documentation to indicate if they are a permanent or

temporary resident of the United States.

STATE OF NEVADA

APPLICATION FOR CONCEALED FIREARM PERMIT

Please type or print In black ink

Full Name {Last Fin:, and middle) Home Phone

Cell Phone

Physical Address {Number. Street. Apt4. Cffy. State. Zp)

Mailing Address [Ifdifferent from above) Business Phone

Initial ApoilcationC

Renewal Application D

Country 0/ Citizenship Place of Birth Alien Number Alien Expiration

lecfM Race Height Weight Hair Eyes Social Security!* Scars. Marks. Tattoos

Occupation Name and Address cf Employer

Answereach question and place a check mark In the appropriate box

1. Are there currently any outstanding warrants foryour arrest? D Yes • No

2. Have ycu ever been judicially declared mentally incompetent or insane? • Yes D No

3. Have you ever been admitted to a mental facility? • Yes • No

4. During the 5 years immediately preceding the date of this application, have you been convicted cf drivingunder the influence of alcoholic or controlled substance in this or any other state? D Yes D No

5. During Ihe 5 years immediately precedingthe date of this application, have you habitually used intoxicatingliquor or narcotics to the extent that your normal facullies were impaired? Q Yes • No

6. During the 5 years immediately preceding the date of this application, have you been committed for treatmentof the abuse of alcoholic beverages in this or any other stats? O Yes D No

7. During the 5 years immediately preceding the date of this application, have you been committed for treatment of.or convicted of a crime related to controlled substance in this or any other state? D Yes • No

8. During the 3 years immediately preceding the date of this application, have you been convicted of a crimeinvolving the use or threatened use offeree or violence punishableas a misdemeanor? Q Yes G No

9. Have you ever been convicted of a felony in this state or any other state? • Yes D Mo

10. During the 5 years immediately preceding the date of Ihis application, have you been subject to any requirementsimposed by a court as a condition to the courts withholding the entry of judgment or suspension of a sentence,fcr the conviction of a felony? O Yes • No

11. Have you ever been convicted of a crime involving domestic violence or stalking in this or any other state?DYes GNo

12. Areyou currentlysubject to a restraining order, injunction or other order for protection against domestic violencein this or any other state? G Yes a No

13. Are you currently on paroleor probation for a conviction in this or any other state? G Yes G No

14. Have you ever renounced your United States Citizenship? Q Yes G No

15. Have you been dishonorably discharged from the Armed Forces? G Yes Q Mo

DO MOT WRITE IN THIS AREA. POLICE AGENCY USE ONLY.

STATE OF NEVADA

APPLICATION FOR CONCEALED FIREARM PERMIT

List all residences, starting with your current address, for the past 10 years (5 years fori '-ill; i/iiiOi

Address (including Apt #) City & SlateDate of Residence

From: To:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

List all other names used (including first, middle, last, and maiden name)

1. 3.

2. J4.AFFIDAVIT

THIS APPLICATION IS EXECUTED UNDER OATH. FALSIFICATION OR MISREPRESENTATION OF ANY PART OR ANY

PART OF ANY DOCUMENT SUBJECTS THE APPLICANT TO DENIAL OR REVOCATION OF THE PERMIT FOR WHICH

THIS APPLICATION IS SUBMITTED.

Before me this day personally appeared ,

who being duly sworn, deposes and says:Name of Applicant

I DO HEREBY SWEAR AND AFFIRM UNDER PENALTY OF PERJURY THAT THE FOLLOWING ASSERTIONS ARE TRUE

AND CORRECT:

A. The information contained in this application and all attached documents are true and correct to the best of myknowledge.

B. I agree to immediately notify the issuing agency Concealed Weapons Unit ifcharged, arrested, or convicted ofany crime in this state or under the laws of any state, or territory or possession of the United States.

Date

Signature of Applicant

TYPE OF IDENTIFICATION PRODUCED

D Driver's License Number: Expiration Date:. State:

G Identification Card Number: Expiration Date:. State:

Sheriffs" Employee:

'•'<•..

Issued to:

L

Nevada Sheriffs and Chiefs

Firearms Safety CourseCertification of Completion

and Firearms Proficiency Certificate(TO BE COMPLETED BY INSTRUCTOR ONLY)

Date:Applicant - Please print clearly

, ail instructor forInstructor's Name - Please Prim Clearly Name of Business - Please Print Clearlv

certify that theabove named applicant has completed a course of instruction to include the following:Applicant Instructor

Initials Initials

Successfully completed a courseof instruction and demonstrated proficiency in basic firearm knowledgeand the safe handling of firearms.Successfully completed a course of instruction and demonstrated proficiency in ammunition knowledgeand the safe handling of ammunition.Successfully completed a course of instruction and demonstrated proficiency in thecleaning and thecareof firearms.

Successfully completed a courseof instruction and demonstrated proficiency in storage and child proofingfirearms.

Successfully completed a course of instruction anddemonstrated proficiency in handgun shootingtechniques and positions.Successfully completed a course of instruction in the laws pertaining to the use of firearms in the State ofNevada and the Countv in which the application is submitted.Successfully completed a courseof instruction in the useof deadly force, the force continuum, civil andcriminal liability.Successfully completed a course of instruction in the knowledge of avoiding criminal attack andcontrolling a violent confrontation.Successfully completed a course of instruction and demonstrated proficiency in firing a handgun andramie safety.Successfully completed and passed a written examination and a firearms qualification course as required.

Circle all that apply

Full Course (8 Hours): Yes / No If Yes, Written Test: Pass / Fail

Renewal Course (4 Hours): Yes / No

This certificate satisfies State of Nevada CCW Permit Instructions Requi rements.

Location of Classroom and Range (County) *

Classroom

Date: Time:

RangeDate: Time:

Instructor Signature

Under penalty of perjury, I attest that I have completed an approved course of instruction and qualified with ahandgun.

Applicant Signature

TO WHOM IT MAY CONCERN:

WAIVER AND AUTHORIZATION

TO RELEASE INFORMATION

Iauthorize you to furnish the Elko County Sheriff's Office with anyand allinformation that youhave concerning me.my employment records, my reputation, my physical and mental condition and my military service records.Information of a confidential or privileged nature may be included. Your reply will be used to assist the policedepartmentin determining my qualifications and suitability for a Concealed Firearms Permit.

In compliance with Federal Confidentiality Rules (42 CFR, Part 2), this waiver includes the release of medicalrecords pertaining to the voluntary and/or involuntary commitment to a mental health facility for treatment ofphysical and mental illness and alcohol/drug abuse.

Inaddition to the above requested information, you may release arrests, detentions, field citations, field interviewcards, officers' records, jail/custody booking records, traffic citations, and traffic accident information, districtattorney records, court records and reports, probation and parole reports and records, laboratory reports andresults,and any other criminal justice records, reports or information source.

This authorization and request is given freely and without duress, voluntarily waiving any protection againstunauthorized disclosure of information under the Privacy Act and any other legal provisions, and with theunderstanding that information furnished will be used by the Elko County Sheriffs Office in conjunction with myapplication for a Concealed Firearms Permit

I hereby release you, your organization and others from any liability or damage which may result from furnishingthe information requested, including any liability pursuant to any state or local code or ordinance or any similarlaws.

Print Full Name:

/ declareunderpenalty ofperjury under the laws ofthe State ofNevada, that the foregoing is true and correct.

Applicant'sSignature Date

SHERIFFS' Employee Date

NOTE: A PHOTOCOPY REPRODUCTION OF THIS REQUEST SMALL BE FOR ALL INTENTS AND PURPOSES AS VALID AS THE ORKHNAL. YOUHAY RETAIN THIS FORM FOR YOUR FILES.

Concealed Firearms

NRS 202.3653 Definitions. As used in NRS 202.3653 to 202.369, inclusive, unless the context

otherwise requires:1. "Concealed firearm" means a loaded or unloaded handgun which is carried upon a person in

such a manner as not to be discernible by ordinary observation.

2. "Department" means the Department of Public Safety.3. "Handgun" has the meaning ascribed to it in 18 U.S.C. § 921(a)(29).4. "Permit" means a permit to carry a concealed firearm issued pursuant to the provisions of NRS

202.3653 to 202.369, inclusive.

(Added to NRS by 1995,2721; A 1997. 1175; 1999.850; 2001.2579; 2005. 596; 2007.3151; 2013, 1138)

NRS 202.3657 Application for permit; eligibility; denial or revocation of permit.1. Any person who is a resident of this State may apply to the sheriff of the county in which he or

she resides for a permit on a form prescribed by regulation of the Department. Any person who is not aresident of this State may apply to the sheriff of any county in this State for a permit on a formprescribed by regulation of the Department. Application forms for permits must be furnished by thesheriff of each county upon request.

2. A person applying for a permit may submit one application and obtain one permit to carry allhandguns owned by the person. The person must not be required to list and identify on the applicationeach handgun owned by the person. A permit is valid for any handgun which is owned or thereafterobtained by the person to whom the permit is issued.

3. Except as otherwise provided in this section, the sheriff shall issue a permit to any person who isqualified to possess a handgun under state and federal law, who submits an application in accordancewith the provisions of this section and who:

(a) Is 21 years of age or older;(b) Is not prohibited from possessing a firearm pursuant to NRS 202.360; and(c) Demonstrates competence with handguns by presenting a certificate or other documentation to

the sheriff which shows that the applicant:(1) Successfully completed a course in firearm safety approved by a sheriff in this State; or(2) Successfully completed a course in firearm safety offered by a federal, state or local law

enforcement agency, community college, university or national organization that certifies instructors in

firearm safety.

** Such a course must include instruction in the use of handguns and in the laws of this State relating to

the use of a firearm. A sheriff may not approve a course in firearm safety pursuant to subparagraph (1)unless the sheriff determines that the course meets any standards that are established by the NevadaSheriffs' and Chiefs' Association or, if the Nevada Sheriffs' and Chiefs' Association ceases to exist, its

legal successor.

4. The sheriff shall deny an application or revoke a permit if the sheriff determines that theapplicant or permittee:

(a) Has an outstanding warrant for his or her arrest.(b) Has been judicially declared incompetent or insane.(c) Has been voluntarily or involuntarily admitted to a mental health facility during the immediately

preceding 5 years.

(d) Has habitually used intoxicating liquor or a controlled substance to the extent that his or hernormal faculties are impaired. For the purposes of this paragraph, it is presumed that a person has soused intoxicating liquor or a controlled substance if, during the immediately preceding 5 years, theperson has been:

(1) Convicted of violating the provisions of NRS484C.110; or(2) Committed for treatment pursuant to NRS 458.290 to 458.350, inclusive.

(e) Has been convicted of a crime involving the use or threatened use of force or violence

punishable as a misdemeanor under the laws of this or any other state, or a territory or possession ofthe United States at any time during the immediately preceding 3 years.

(f) Has been convicted of a felony in this State or under the laws of any state, territory or possessionof the United States.

(g) Has been convicted of a crime involving domestic violence or stalking, or is currently subject to arestraining order, injunction or other order for protection against domestic violence.

(h) Is currently on parole or probation from a conviction obtained in this State or in any other stateor territory or possession of the United States.

(i) Has, within the immediately preceding 5 years, been subject to any requirements imposed by acourt of this State or of any other state or territory or possession of the United States, as a condition tothe court's:

(1) Withholding of the entry of judgment for a conviction of a felony; or(2) Suspension of sentence for the conviction of a felony.

(j) Has made a false statement on any application for a permit or for the renewal of a permit.

5. The sheriff may deny an application or revoke a permit if the sheriff receives a sworn affidavitstating articulable facts based upon personal knowledge from any natural person who is 18 years of ageor older that the applicant or permittee has or may have committed an offense or engaged in any otheractivity specified in subsection 4 which would preclude the issuance of a permit to the applicant orrequire the revocation of a permit pursuant to this section.

6. If the sheriff receives notification submitted by a court or law enforcement agency of this or any

other state, the United States or a territory or possession of the United States that a permittee or an

applicant for a permit has been charged with a crime involving the use or threatened use of force or

violence, the conviction for which would require the revocation of a permit or preclude the issuance of apermit to the applicant pursuant to this section, the sheriff shall suspend the person's permit or the

processing of the person's application until the final disposition of the charges against the person. If apermittee is acquitted of the charges, or if the charges are dropped, the sheriff shall restore his or herpermit without imposing a fee.

7. An application submitted pursuant to this section must be completed and signed under oath by

the applicant. The applicant's signature must be witnessed by an employee of the sheriff or notarized by

a notary public. The application must include:

(a) The name, address, place and date of birth, social security number, occupation and employer ofthe applicant and any other names used by the applicant;

(b) A complete set of the applicant's fingerprints taken by the sheriff or his or her agent;(c) A front-view colored photograph of the applicant taken by the sheriff or his or her agent;(d) If the applicant is a resident of this State, the driver's license number or identification card

number of the applicant issued by the Department of Motor Vehicles;

(e) If the applicant is not a resident of this State, the driver's license number or identification cardnumber of the applicant issued by another state or jurisdiction;

(f) A nonrefundable fee equal to the nonvolunteer rate charged by the Central Repository forNevada Records of Criminal History and the Federal Bureau of Investigation to obtain the reports

required pursuant to subsection 1 of NRS 202.366; and

(g) A nonrefundable fee set by the sheriff not to exceed $60.(Added to NRS by 1995.2721; A 1997. 1175; 2001,612, 618, 2579; 2003. 8, U_; 2007.3151: 2011,751, 1779,

3107:2013. 1139)

NRS 202.366 Investigation of applicant for permit; issuance or denial of permit; expiration ofpermit.

1. Upon receipt by a sheriff of an application for a permit, including an application for the renewal

of a permit pursuant to NRS 202.3677, the sheriff shall conduct an investigation of the applicant todetermine if the applicant is eligible for a permit. In conducting the investigation, the sheriff shall

forward a complete set of the applicant's fingerprints to the Central Repository for Nevada Records ofCriminal History for submission to the Federal Bureau of Investigation for its report concerning the

criminal history of the applicant. The investigation also must include a report from the National InstantCriminal Background Check System. The sheriff shall issue a permit to the applicant unless the applicantis not qualified to possess a handgun pursuant to state or federal law or is not otherwise qualified toobtain a permit pursuant to NRS 202.3653 to 202.369, inclusive, or the regulations adopted pursuant

thereto.

2. To assist the sheriff in conducting the investigation, any local law enforcement agency, includingthe sheriff of any county, may voluntarily submit to the sheriff a report or other information concerningthe criminal history of an applicant.

3. Within 120 days after a complete application for a permit is submitted, the sheriff to whom theapplication is submitted shall grant or deny the application. If the application is denied, the sheriff shallsend the applicant written notification setting forth the reasons for the denial. If the application isgranted, the sheriff shall provide the applicant with a permit containing a colored photograph of theapplicant and containing such other information as may be prescribed by the Department. The permitmust be in substantially the following form:

NEVADA CONCEALED FIREARM PERMIT

County Permit Number

Expires Date of Birth

Height Weight

Name Address

City Zip

PhotographSignature

Issued by

Date of Issue

4. Unless suspended or revoked by the sheriff who issued the permit, a permit expires 5 years afterthe date on which it is issued.

5. As used in this section, "National Instant Criminal Background Check System" means the nationalsystem created by the federal Brady Handgun Violence Prevention Act, Public Law 103-159.

(Added to NRS by 1995, 2723: A 1999, 2094; 2001, 614, 620; 2003, 13, 2846; 2007. 3153; 2011, 754, 1781,3109:2013, 1141)

NRS 202.3662 Confidentiality of information about applicant for permit and permittee.1. Except as otherwise provided in this section and NRS 202.3665 and 239.0115:

(a) An application for a permit, and all information contained within that application;(b) All information provided to a sheriff or obtained by a sheriff in the course of the investigation of

an applicant or permittee;

(c) The identity of the permittee; and(d) Any records regarding the suspension, restoration or revocation of a permit,