Fillable Printable Consent Form for Criminal Record Check For Petitioner Seeking Restoration of Firearms Rights
Fillable Printable Consent Form for Criminal Record Check For Petitioner Seeking Restoration of Firearms Rights
Consent Form for Criminal Record Check For Petitioner Seeking Restoration of Firearms Rights
Consent Form for Criminal Record Check
For Petitioner Seeking
Restoration of Firearms Rights
( Statutory Authority: N.C.G.S. §§ 14-415.4, 114-19.28 )
1.
I authorize and consent to the North Carolina State Bureau of Investigation’s use of my fingerprints and other identifying
information to perform a search of the State and National criminal history record file databases for any criminal history
information contained therein on me. I further authorize and consent to the North Carolina State Bureau of Investigation
forwarding my consent form, fingerprints, and other information to the Federal Bureau of Investigation for a search of the
National criminal history databases.
2.
I understand that the North Carolina State Bureau of Investigation will mail a copy of this form and the results of the search to the
Clerk of Superior Court of the North Carolina County in which I reside.
3.
I understand that I will not be provided a copy of these results.
4.
I understand that the North Carolina State Bureau of Investigation and its officials and employees shall not be held legally
accountable in any way for providing this information for the above purpose, and I hereby release said agency and persons from
any and all liability which may be incurred as a result of furnishing such information.
5.
I understand that the following items are required for completion of my request:
A.
Completed Firearms – Restoration of Rights Consent Form. Please make a copy for personal records and ensure original
is submitted as directed below. (N.C.G.S. §14-415.4)
B.
Complete set of fingerprints on an FD-258 applicant fingerprint card.
C.
$38.00 processing fee for completing this request. (N.C.G.S. §114-19.28)
The fee must be in the form of a certified check or money order made payable to NC State Bureau of Investigation.
NO PERSONAL CHECKS WILL BE ACCEPTED.
6.
All items (A–C) are to be mailed by the Sheriff’s Office to:
North Carolina State Bureau of Investigation — Criminal Information and Identification Section
Post Office Box 29500 — Raleigh, North Carolina 27626-0500
Applicant Signature Date
( PLEASE TYPE OR PRINT CLEARLY )
Last Name First Name Middle Name Maiden Name
Any other Names, Nicknames or Aliases SSN* (optional)
Date of Birth Gender Race NC County of Residence
* Disclosure of social security number is voluntary and not required. If disclosed, the social security number will be utilized to assist
with accurate identification/exclusion of possible criminal history records.
FBI CJIS policy requires this form be maintained on file by the Clerk of Superior Court for one year.
