CRIMINAL HISTORY RECORD CHECK CONSENT FORM

CRIMINAL HISTORY RECORD CHECK
CONSENT FORM
CHATHAM COUNTY PROBATE COURT
I hereby authorize the Chatham County Probate Court to receive a background check of the Federal
Bureau of Investigation’s National Instant Criminal Background Check System prior to the
issuance of a Firearm license or a renewal.
Full Name (print)
______________________________________________________________________________
Maiden Name
______________________________________________________________________________
Alias Names
Address
Date of Birth
Sex
Race
Place of Birth
Signature
Date
---------------------------------------------------------------------------------------------------------------------Probate Court Use Only
(Purpose Code “F”)
License Number
Record Checked By:
Results:
Date