Livescan Pre-Registration Application

Livescan Pre-Registration Application

LIVESCAN PRE-REGISTRATION APPLICATION

First Name *

Middle Initial

Last Name *

Date of Birth *

Gender *

Male

Female

Height *

Example 5 Foot 6 Inches

Weight *

Weight in pounds.

Eye Color *

Hair Color *

Race *

Black

White

Asian/Pacific Islander

Native American

Other

Place of Birth *

Citizenship

Address *

City

Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

State/Province

Zip/Postal

Daytime Phone *

Evening Phone *

Application Type? * Handgun Permit Livescan Pre-Registration Application HQL Livescan Pre-Registration Application Other Livescan Pre-Registration Application

Agency Information

Agency Authorization #

ORI # (If Required)

Reason Fingerprinted?

Agency Information

Agency Authorization #

ORI # (If Required)

Reason Fingerprinted?

Agency Information

Agency Authorization #

ORI # (If Required)

Reason Fingerprinted?