SHERIFF OF DELAWARE COUNTY

MEDIA, PENNSYLVANIA 19063

PHONE 610-891-4296 - FACSIMILE 610-891-1765

Jerry L. Sanders, Jr. Michellene M. Conte

Sheriff Chief Deputy

NEW PERMITS
1. PLEASE FILL OUT THE APPLICATION IN FULL. PHOTOGRAPH IS REQUIRED AND WILL BE
TAKEN AT TIME OF APPLICATION.
2. PLEASE RETURN THE APPLICATION IN PERSON BETWEEN 9:00 A.M. AND 3:30 P.M.
3. DO NOT SIGN THE APPLICATION UNTIL YOU ARE IN THE PRESENCE OF A CLERK IN THE
SHERIFF’S OFFICE.
4. YOU MUST BRING THE APPLICATION IN PERSON WITH THE PROPER IDENTIFICATION, THAT
IS:
a. GOVERNMENT ISSUED PHOTO IDENTIFICATION THAT IS NOT EXPIRED AND
CONTAINS NAME, CURRENT ADDRESS THAT MATCHES APPLICATION, DATE OF
BIRTH AND SIGNATURE. NO P.O. BOXES WILL BE ACCEPTED.
b. OUT-OF-STATE APPLICANTS MUST HAVE THE ABOVE IDENTIFICATION AND
POSSESS A VALID UNRESTRICTED PERMIT TO CARRY FROM THEIR HOME STATE
IF PROVIDED BY LAW.
5. REFERENCES ARE OPTIONAL. IF YOU LIST REFERENCES, NO MEMBER OF THE SHERIFF’S
OFFICE, CHIEF OF POLICE, OR JUDGE OF ANY KIND MAY BE USED AS A REFERENCE. YOU
MAY NOT USE MEMBERS OF THE SAME HOUSEHOLD, OR FAMILY MEMBER.
6. NON - U.S. CITIZENS:
IF YOU ARE NOT A CITIZEN, YOU MUST PRESENT VALID DOCUMENTATION THAT SHOWS
YOU ARE LAWFULLY IN THE U.S. – THAT IDENTIFICATION MUST SHOW AN ALIEN
REGISTRATION NUMBER, OR I-94 NUMBER WHICH IS REQUIRED FOR THE APPLICATION.
7. PLEASE BRING $20.00 IN CASH, OR A MONEY ORDER. THE SHERIFF’S OFFICE CANNOT
ACCEPT CHECKS.

RENEWALS
1. PLEASE FILL OUT THE APPLICATION IN FULL. PHOTOGRAPH IS REQUIRED AND WILL BE
TAKEN AT TIME OF APPLICATION. PHOTO WILL BE TAKEN OF APPLICANT’S HEAD AND
SHOULDERS (NO SUNGLASSES, HATS, BANDANNA, ETC. WILL BE WORN TO OBSTRUCT THE
HEAD).
2. PLEASE RETURN THE APPLICATION IN PERSON BETWEEN 9:00 A.M. AND 3:30 P.M.
3. DO NOT SIGN THE APPLICATION UNTIL YOU ARE IN THE PRESENCE OF A CLERK IN THE
SHERIFF’S OFFICE.
4. YOU MUST BRING THE APPLICATION IN PERSON WITH THE PROPER IDENTIFICATION, THAT
IS:
a. GOVERNMENT ISSUED PHOTO IDENTIFICATION THAT IS NOT EXPIRED AND
CONTAINS NAME, CURRENT ADDRESS THAT MATCHES APPLICATION, DATE OF
BIRTH AND SIGNATURE.
b. OUT-OF-STATE APPLICANTS MUST HAVE THE ABOVE IDENTIFICATION AND
POSESS A VALID UNRESTRICTED PERMIT TO CARRY FROM THEIR HOME STATE
IF PROVIDED FOR BY LAW.
c. EXISTING DELAWARE COUNTY-ISSUED PERMIT NEARING EXPIRATION.
5. REFERENCES ARE OPTIONAL. IF YOU LIST REFERENCES, NO MEMBER OF THE SHERIFF’S
OFFICE, CHIEF OF POLICE, OR JUDGE OF ANY KIND MAY BE USED AS A REFERENCE. YOU
MAY NOT USE MEMBERS OF THE SAME HOUSEHOLD, OR FAMILY MEMBER.
6. NON – U.S. CITIZENS:
IF YOU ARE NOT A CITIZEN, YOU MUST PRESENT VALID DOCUMENTATION THAT SHOWS
YOU ARE LAWFULLY IN THE U.S. - THAT IDENTIFICATION MUST SHOW AN ALIEN
REGISTRATION NUMBER, OR I-94 NUMBER WHICH IS REQUIRED FOR THE APPLICATION.
7. PLEASE BRING $20.00 IN CASH OR A MONEY ORDER. THE SHERIFF’S OFFICE CANNOT
ACCEPT CHECKS
YOU MAY APPLY UP TO 2 MONTHS PRIOR TO YOUR EXPIRATION
DATE.
YOU WILL BE NOTIFIED BY MAIL AS TO YOUR APPROVAL OR
DENIAL WITHIN 45 DAYS.
 ON-LINE APPLICATION
1. You can apply on-line at https://delawarepa.permitium.com/ccw/start follow instructions. Note that for
online applications there is a $5.00 convenience fee – only one visit required.
2. Once approved, you will receive either a phone call, text, and or an email to come into the Office to have
your picture and signature captured, then your license to carry permit will be issued.

REPLACEMENT
LOST OR STOLEN – NAME CHANGE – CHANGE OF ADDRESS
1. Complete the Lost or Stolen Form, if have a police report provide same.
2. Applicants, who have had a NAME CHANGE, must submit legal documents to show the name change (i.e.,
Marriage License, Court Orders).
3. Acceptable examples for proof of RESIDENCY with applicant’s name, but not limited to:
Current bills such as:
- Phone bill
- Electric bill
- Gas bill
- Water bill
- Cable/satellite bill
- Credit card statements
- Bank/student loan statements
- Valid vehicle registration
- Valid vehicle insurance card
- Voter registration card
JUNK MAIL IS NOT ACCEPTABLE
4. Fee for replacement is $5.00.

NOTICE!!!
Please note, all information provided as part of the application process is
confidential and not subject to public disclosure under Title 37 PA Chapter 31
Sec 33.103. Hence, we will not release any information if you call us or if
another person requests on your behalf. Also, disclosure of social security
numbers is voluntary. However, not providing your social security number may
result in Pennsylvania State Police not being able to positively identify you from
any possible disqualifying records. This will result in Pennsylvania State Police
not being able to approve your application. All other information requested on
this application is required and must be complete and accurate. ALL
APPLICANTS SHOULD BE AWARE THAT FALSE STATEMENTS
(WHETHER ORAL OR WRITTEN) WILL BE CAUSE FOR DENIAL AND
MAY RESULT IN ARREST. IT IS YOUR RESPONSIBILITY TO NOTIFY US
OF ANY ADDRESS CHANGES, OR FUTURE RENEWAL NOTICES WILL
NOT REACH YOU. IF YOU ALLOW YOUR LICENSE TO EXPIRE, YOU
WILL BE RESPONSIBLE FOR ANY CRIMINAL PENALTIES FOR
CARRYING A FIREARM WITHOUT A LICENSE.

(DCSO Rev. Oct. 2024)

SP 4-127 (7-2024) COMMONWEALTH OF PENNSYLVANIA
RENEWAL
COUNTY OF______________________________
APPLICATION FOR A PENNSYLVANIA LICENSE TO CARRY FIREARMS
FOR USE BY ISSUING AUTHORITY: PICS Temp App. No _____________ PICS Perm. App. No. ______________ Application Date _____________
License No. _________________ Temporary License Approval Date __________________ Permanent License Approval Date ___________________

Rejection Date ____________ Reason for Rejection _________________________________ Signature ____________________________________

APPLICANT INFORMATION – TYPE/PRINT IN BLUE OR BLACK INK

1. LAST NAME 2. JR., ETC. 3. FIRST NAME 4. MIDDLE NAME 5. PHOTO ID/DRIVER LICENSE NO. 6. STATE

7a. DATE OF BIRTH 7b. PLACE OF BIRTH 8. SOCIAL SECURITY NUMBER 9. AGE 10. SEX 11. RACE 12. HEIGHT 13. WEIGHT 14. HAIR COLOR 15. EYE COLOR
(Optional)

16. STREET ADDRESS 17. CITY 18. STATE 19. ZIP CODE 20. TELEPHONE NO.

21. PERSONAL EMAIL (Blocks 21-23 Optional) 22. EMPLOYER/BUSINESS NAME 23. WORK TELEPHONE NO.

24. REASON FOR A LICENSE TO CARRY FIREARMS:

SELF-DEFENSE EMPLOYMENT HUNTING/FISHING TARGET SHOOTING GUN COLLECTING OTHER

___________________________
25. TWO REFERENCES (Optional) NOT FAMILY MEMBERS
NAME ADDRESS TELEPHONE NO.

NAME ADDRESS TELEPHONE NO.

APPLICANTS ARE DETERMINED TO BE ELIGIBLE FOR A LICENSE TO CARRY FIREARMS BASED UPON CRITERIA LISTED IN 18 Pa.C.S. § 6109.

26. DO ANY OF THESE PROHIBITING CRITERIA UNDER 18 PA.C.S. § 6109(e)(1) APPLY TO YOU? CHECK YES OR NO:

A. IS YOUR CHARACTER AND REPUTATION SUCH THAT YOU WOULD BE LIKELY TO ACT IN A MANNER DANGEROUS TO PUBLIC
SAFETY? YES NO

B. HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE UNDER THE PENNSYLVANIA CONTROLLED SUBSTANCE, DRUG, DEVICE
AND COSMETIC ACT (CSDDCA)? (ANY PENNSYLVANIA DRUG CONVICTION UNDER THE CSDDCA IS PROHIBITING FOR A YES NO
LICENSE TO CARRY.)
C. HAVE YOU EVER BEEN CONVICTED OF A CRIME LISTED IN 18 PA.C.S. § 6105(b), OR DO ANY OF THE CONDITIONS LISTED IN
18 PA.C.S. § 6105(c) APPLY TO YOU? (READ INFORMATION ON BACK PRIOR TO ANSWERING) YES NO
D. HAVE YOU EVER BEEN ADJUDICATED DELINQUENT FOR A CRIME LISTED IN 18 PA.C.S. § 6105 OR FOR AN OFFENSE UNDER
THE CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT? YES NO
E. HAVE YOU EVER BEEN INVOLUNTARILY COMMITTED TO A HOSPITAL/HEALTH CARE FACILITY FOR A MENTAL HEALTH
CONDITION OR OTHER TREATMENT, OR ADJUDICATED INCOMPETENT/INCAPACITATED? YOU MAY CHECK “NO” IF YOU HAVE
BEEN GRANTED RELIEF OR EXPUNGEMENT IN PENNSYLVANIA PURSUANT TO EITHER 18 PA.C.S. 6105(F)(1) OR 6111.1(G)(2), OR BY YES NO
THE ADJUDICATING/COMMITTING STATE PURSUANT TO A QUALIFYING MENTAL HEALTH RELIEF FROM DISABILITIES PROGRAM, AS
SET FORTH IN 34 U.S.C. § 40915.

F. ARE YOU AN INDIVIDUAL WHO IS A HABITUAL DRUNKARD, OR WHO IS ADDICTED TO OR AN UNLAWFUL USER OF MARIJUANA
OR A STIMULANT, DEPRESSANT, OR NARCOTIC DRUG? YES NO
G. ARE YOU NOW CHARGED WITH, OR HAVE YOU EVER BEEN CONVICTED OF A CRIME PUNISHABLE BY IMPRISONMENT FOR A
TERM EXCEEDING ONE YEAR? THIS IS THE MAXIMUM SENTENCE YOU COULD HAVE RECEIVED, NOT THE ACTUAL
SENTENCE YOU DID RECEIVE. (IT DOES NOT INCLUDE FEDERAL OR STATE OFFENSES PERTAINING TO ANTITRUST, UNFAIR YES NO
TRADE PRACTICES, RESTRAINTS OF TRADE, OR REGULATION OF BUSINESS; OR STATE OFFENSES CLASSIFIED AS
MISDEMEANORS AND PUNISHABLE BY A TERM OF IMPRISONMENT NOT EXCEEDING TWO YEARS.)
H. HAVE YOU EVER RECEIVED A DISHONORABLE DISCHARGE FROM THE UNITED STATES ARMED FORCES? YES NO
I. ARE YOU A FUGITIVE FROM JUSTICE? THIS DOES NOT APPLY TO MOVING OR NONMOVING SUMMARY OFFENSES UNDER
TITLE 75 (RELATING TO MOTOR VEHICLES), BUT DOES INCLUDE OUTSTANDING ARREST AND BENCH WARRANTS.
YES NO
J. ARE YOU PROHIBITED FROM POSSESSING OR ACQUIRING A FIREARM UNDER THE STATUTES OF THE UNITED STATES? YES NO
27. ARE YOU A UNITED STATES CITIZEN? IF NO, COUNTRY OF BIRTH___________________________________________
COUNTRY OF CITIZENSHIP____________________________________ ALIEN REGISTRATION # OR I-94#______________________________
YES NO
28. IF YOU ARE A RESIDENT OF ANOTHER STATE, DO YOU POSSESS A CURRENT LICENSE, PERMIT, OR SIMILAR DOCUMENT TO CARRY A
FIREARM ISSUED BY THAT STATE? IF YES, ATTACH A PHOTOCOPY OF THE DOCUMENT TO THIS FORM.
YES NO
29. ARE YOU CURRENTLY ON ANY TYPE OF PROBATION/PAROLE WHICH PROHIBTS THE POSSESSION OR CONTROL OF A FIREARM? YES NO
30. I have never been convicted of a crime that prohibits me from possessing or acquiring a firearm under Federal or State law. I am of sound mind and have
never been committed to a mental institution or mental health care facility. I hereby certify that the statements contained herein are true and correct to the
best of my knowledge and belief. I understand that if I knowingly make any false statements herein, I am subject to penalties prescribed by law. I authorize
the sheriff, or his designee, or, in the case of first-class cities, the chief or head of the police department, or his designee, to inspect only those records or
documents relevant to information required for this application. If I am issued a license and knowingly become ineligible to legally possess or acquire
firearms, I will promptly notify the sheriff of the county in which I reside or, if I reside in a city of the first class, the chief of police of that city.
This certification is made subject to both the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsifications to authorities and the Uniform Firearms Act.

SIGNATURE - APPLICANT _____________________________________________________ DATE OF APPLICATION _________________________

18 Pa.C.S. Section 6105(a)(1): A person who has been convicted of an offense enumerated in subsection (b), within or without this Commonwealth,
or whose conduct meets the criteria in subsection (c) shall not possess, use, control, sell, transfer or manufacture or obtain a license to possess,
use, control, sell, transfer, or manufacture a firearm in this Commonwealth.
Section 6105(a.1)(2): A person who is the subject of an active final protection from abuse order issued pursuant to 23 Pa.C.S. § 6108, is the subject
of any other active protection from abuse order issued pursuant to 23 Pa.C.S. § 6107(b) (relating to hearings), which provided for the relinquishment
of firearms or other weapons or ammunition during the period of time the order is in effect, or is otherwise prohibited from possessing or acquiring
a firearm under 18 U.S.C. § 922(g)(8) (relating to unlawful acts), commits a misdemeanor of the second degree if he intentionally or knowingly fails
to relinquish a firearm or other weapon or ammunition.
Section 6105(b)
§908 Prohibited offensive weapons §3921 Theft by unlawful taking or disposition, upon conviction of the
§911 Corrupt organizations second felony offense
§912 Possession of weapon on school property §3923 Theft by extortion, when the offense is accompanied by
§2502 Murder threats of violence
§2503 Voluntary manslaughter §3925 Receiving stolen property, upon conviction of the second
§2504 Involuntary manslaughter, if the offense is based on the felony offense
reckless use of a firearm §4906 False reports to law enforcement authorities, if the fictitious
§2702 Aggravated assault report involved the theft of a firearm as provided in 4906(c)(2)
§2703 Assault by prisoner §4912 Impersonating a public servant if the person is impersonating
§2704 Assault by life prisoner a law enforcement officer
§2709.1 Stalking §4952 Intimidation of witnesses or victims
§2716 Weapons of mass destruction §4953 Retaliation against witness, victim or party
§2901 Kidnapping §5121 Escape
§2902 Unlawful restraint §5122 Weapons or implements for escape
§2910 Luring a child into a motor vehicle or structure §5501(3) Riot
§3121 Rape §5515 Prohibiting of paramilitary training
§3123 Involuntary deviate sexual intercourse §5516 Facsimile weapons of mass destruction
§3125 Aggravated indecent assault §6110.1 Possession of firearm by minor
§3301 Arson and related offenses §6301 Corruption of minors
§3302 Causing or risking catastrophe §6302 Sale or lease of weapons and explosives
§3502 Burglary
§3503 Criminal trespass, if the offense is graded a felony of the Any offense equivalent to any of the above-enumerated offenses
second degree or higher under the prior laws of this Commonwealth, or any offense equivalent
§3701 Robbery to any of the above-enumerated offenses under the statutes of any
§3702 Robbery of motor vehicle other state or of the United States.
Section 6105(c):
18 Pa.C.S. § 6105(c) also prohibits the following persons from possessing, using, controlling, transferring, manufacturing, or obtaining a license to
possess, use, control, transfer, or manufacture a firearm in the Commonwealth of Pennsylvania.
ARE YOU A PERSON WHO:
1. is a fugitive from justice; or
2. has been convicted of an offense under the Pennsylvania Controlled Substance, Drug, Device and Cosmetic Act, or any equivalent Federal
statute or equivalent statute of any other state, that may be punishable by a term of imprisonment exceeding two years; or
3. has been convicted of driving under the influence of alcohol or controlled substance as provided in 75 Pa.C.S. § 3802 (relating to driving under
the influence of alcohol or controlled substance) or the former 75 Pa.C.S. § 3731, on three or more separate occasions within a five-year
period. For the purposes of this paragraph only, the prohibition of Section 6105(a) shall only apply to transfers or purchases of firearms after
the third conviction; or
4. has been adjudicated as an incompetent or who has been involuntarily committed to a mental institution for inpatient care and treatment under
section 302, 303, or 304 of the Pennsylvania Mental Health Procedures Act; or
5. being an alien, is illegally or unlawfully in the United States; or
6. is the subject of an active final protection from abuse order issued pursuant to 23 Pa.C.S. § 6108, is the subject of any other active protection
from abuse order issued pursuant to 23 Pa.C.S. § 6107(b), which provided for the relinquishment of firearms during the period of time the order
is in effect or is otherwise prohibited from possessing or acquiring a firearm under 18 U.S.C. § 922(g)(8). This prohibition shall terminate upon
the expiration or vacation of the order or portion thereof relating to the relinquishment of firearms; or
7. was adjudicated delinquent by a court pursuant to 42 Pa.C.S. § 6341 (relating to adjudication) or under any equivalent Federal statute or statute
of any other state as a result of conduct which if committed by an adult would constitute an offense under 18 Pa.C.S. sections 2502, 2503,
2702, 2703, 2704, 2901, 3121, 3123, 3301, 3502, 3701, and 3923; or
8. was adjudicated delinquent by a court pursuant to 42 Pa.C.S. § 6341 or under any equivalent Federal statute or statute of any other state as a
result of conduct which if committed by an adult would constitute an offense enumerated in 18 Pa.C.S. § 6105(b) with the exception of those
crimes set forth in paragraph 7. This prohibition ends 15 years after the delinquency adjudication or upon the person reaching the age of 30,
whichever is earlier.
9. is prohibited from possessing or acquiring a firearm under 18 U.S.C. § 922(g)(9) (Misdemeanor Crime of Domestic Violence). 18 U.S.C. §
921(a)(33) generally states that the term “misdemeanor crime of domestic violence” means an offense that— (i) is a misdemeanor under
Federal, State, Tribal, or local law; and (ii) has, as an element, the use or attempted use of physical force, or the threatened use of a deadly
weapon, committed by a current or former spouse, parent, or guardian of the victim, by a person with whom the victim shares a child in common,
by a person who is cohabiting with or has cohabited with the victim as a spouse, parent, or guardian, by a person similarly situated to a spouse,
parent, or guardian of the victim, or by a person who has a current or recent former dating relationship with the victim.
10. has been convicted of an offense under subsection (a.1)(2). The prohibition shall terminate five years after the date of conviction, final release
from confinement or final release from supervision, whichever is later.
PRIVACY ACT NOTICE
Solicitation of this information is authorized under Title 18 Pa.C.S. § 6111. Disclosure of your social security number is voluntary. Your social security
number, if provided, may be used to verify your identity and prevent misidentification. All information supplied, including your social security number, is
confidential and not subject to public disclosure.