Mendocino County Sheriff's Office

Please read the following before proceeding:

Applicant Information:


Current Concealed Permit Information: enter your existing permit # and the issuing county


Previous Names/Aliases: (please list all previous aliases)

Previous Last Name Previous First Name Previous Middle Name City Where Changed State Court File #

Driver's License / Non-Operator ID: (or other State Issued ID)


Information Related To Your Birth:



Current Military Status:


Demographic Information:

Required Icon Gender:

feet inches

Telephone Number: (###-###-####)


Email:


Please Create A Password: (you can use this to track progress, and we may need to contact you during the process)


Password Information: In order to comply with CJIS standards we have employed the use of a password complexity monitor. As you enter your password, we will display an indicator of complexity. You will only be able to submit passwords that are sufficiently complex as to be considered 'safe' by CJIS standards. The visual indicator will turn Blue or Green to indicate that your password is safe.

Important: CJIS requires we maintain a strict password policy and system of checks. As such, we check the following items as you enter your new password:
  • The password must be a minimum length of eight (8) characters on all systems
  • The password must not be a dictionary word
  • The password must not be the same as your email address
  • The password must not be a proper name

Current Residence Address: (this may be different than your mailing address)


Present Mailing Address: (if different from residence address)


Time At Present Address:


Previous Addresses: if at present address for less than 10 years

Address Line 1 Address Line 2 City State Zip Country From To

Employment Status:


Work Information And Address: (enter your place of employment)


Occupation Field:

Please indicate your current occupation field. Enter unemployed if you currently do not have a job.


You must enter ALL the firearms you want to appear on your CCW license: Max of 3


Attach Documentation: please upload the required documentation

If you need to upload documentation, please use the button below to begin the process. The maximum size of individual files is 5 MB.
  • Valid government issued photo ID (ex. Passport, CA Drivers/State ID)
  • Proof of Residency (2 items - Only required if changing address): utility bill, property tax, credit card bill, vehicle registration, voter registration

Please enter your e-Signature



For security purposes, we logged your IP Address: 216.73.216.204, 162.159.115.42:43522, 40.1.2.113
User's Signature

Application Qualification Questions:

Are you changing your address?

Are you changing your name?

Are you changing the weapons on your permit?

 Please provide an explanation for the reason for the modification application.


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