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APPLICATION LICENSE TO SELL CONCEALABLE FIREARMS (This form must be completed by each owner/partner/applicant) Fee: $30.00 New [ ] $20.00 Renewal [ ] Fee received Last Name First Name Middle Name Home Residence Address Business City/State/Zip Contact Email Sex: M / F Date of Calif. Driver’s Lic. BUSINESS WILL YOU BE SELLING USED GUNS?: REQUIRED ATTACHMENTS: 1) Copy of your Firearms License issued by the US Bureau of Alcohol, Tobacco & Firearms 2) Copy of your Business License issued by the City of Modesto 3) Copy of your Department of Justice Certificate of Eligibility to Sell Firearms 4) Copy of your Seller’s Permit issued by the State Board of Equalization 5) Copy of your state Driver’s License or state Identification Card License To Sell Concealable Firearms Number Have you ever been arrested? Yes / No If yes, when did the arrest take In what What was the arrest Are you currently or have you ever been treated for a mental illness? LYING ON THIS APPLICATION IS REASON FOR DENIAL (480 B&P) I HEREBY CERTIFY THAT THE PROVIDED INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE TITLE DATE In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at SIGN