Jacquelynne Kincaid Application for Firearms Permit

Personal Information:
1. Full Name:Jacquelynne_Kincaid
2. Date of Birth:08-06-1957
3. Gender:Female
4. Nationality:Greek/Jewish
5. Address:50
  - Street:Red County
  - City:Blueberry
  - State/Province:California
  - Zip Code:(?????)

Contact Information:
6. Email Address:jdkincaid@post.com
7. Phone Number:578-1624

Background Information:
8. Occupation:Deputy
9. Employer: Red County Sheriff Department
10. Have you ever been convicted of a felony? No(Yes/No)
   - If yes, please provide details:

Firearms Training:
11. Have you completed a certified firearms safety course? (Yes/No)Yes
   - If yes, please provide details: San Diego Police Department.
Safe Shooter Certification. Can recite the four basic gun safety rules from memory. Proficient with naming all the parts of a pistol and revolver. Demonstrates how to unloads and loads pistol and revolver. Understands unsafe gun handling. Can correctly perform the 12 step live and dry- fire exercise. Presents from holster on the firing line. Fires 20 shots at 15’ with 10 shots in a 6” circle. Knows correct gun cleaning with pistol and revolver. Demonstrates 100 percent safe gun handling at all times. Understands and follows range commands.
Defensive Shooter Certification. Demonstrates getting off the X before shooting. Demonstrates shooting from cover without revealing location. Is able to fire while moving without tripping. Demonstrates shooting in low light with Harries and FBI methods. Demonstrates draw from fire with holster as open carry as well as concealed. Demonstrates tactical and emergency reloads while shooting. Is able to clear all types of malfunctions while shooting. Successfully demonstrates live fire shooting of 20 shots at 30’ with 10 in a 6” circle. Demonstrates 100 percent safe gun handling at all times. Understands and follows range commands.

Reason for Application:
12. Please provide a detailed explanation of why you are applying for a firearms license: Certification renewal for purposes of continuing my duty as a Law Enforcement Officer.

Firearms Details:
13. Type of firearms class you are applying for: Class A, B, C, D, E. Requesting the additional recognition of Range Safety officer and Instructor certification as recognized by ADTA standards having previously attended and passed a ADTA training class and served a 1 years apprenticeship. This is only a temporary request until a more suitable person is found.
- Class A/Class B/Class C/Class D/Class E

Declaration:
I hereby declare that all information provided in this application is true and accurate to the best of my knowledge. I understand that any false statements may result in the denial or revocation of my firearms license.

Signature:
Jacquelynne Kincaid
(Date 01/19/1994)