Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone

(###)

###

####

Have you ever been convicted of a Class A felony or a felony sex offense?

Yes

No

Do you have any pending criminal charges in any jurisdiction (state, federal, or tribal)?

Yes

No

Have you been convicted of any crime in the past five years?

Yes

No

Have you completed all conditions of your sentence, including any required treatment or restitution?

Yes

No

Are there any active protection orders against you (e.g., domestic violence, anti-harassment, no-contact orders)?

Yes

No

Have you been involuntarily committed for mental health treatment?

Yes

No

Have you previously had your firearm rights restored?

Yes

No

Was your conviction in Washington State?

Yes

No