PRELIMINARY APPLICATION

FOR HANDGUN LICENSE

***Must Reside Inside TOWN LIMITS***

Complete this form for NEW or RENEWAL* Licenses

*Renewal application must be made before current license expires.

License Type                                        Local Fee                                              State Fee

    (Money Order or Certified Check only)

  Made Payable to the STATE of INDIANA

4 Year Hunting                                   $10                                                         $5

And Target____________________________________________________________

4 Year Personal                                    $10                                                       $30

Protection____________________________________________________________

Lifetime Hunting                                 $50                                                        $25

And Target/

No Current License____________________________________________________

Lifetime Hunting                                 $40                                                        $20

And Target/

Current Valid License__________________________________________________

Lifetime Personal                                 $50                                                         $75

Protection/

No Current License____________________________________________________

Lifetime Personal                                  $40                                                         $60

Protection/

Name________________________________________________________________

First                             Middle                                    Last

Address______________________________________________________________

Date of Birth______- ____-______   Place of Birth______________-_____________

                                                                                    County                               State

Soc. Sec. #_______-_____-________            Drivers License #____________________

Sex______ Race_____      Phone# Day_________________Eve.__________________

You will be contacted for appointment after criminal checks are completed.

Return this form to the Town Hall or,

Mail to, Russiaville PD, PO Box 278, Russiaville, IN 46979