Request for Administrative Review

Illinois State Police – Firearms Services Bureau
Request for Administrative Review
Revocation/Denial/Suspension of Concealed Carry License/Application
I, ____________________________________, request the Illinois State Police, Firearms Services Bureau, Appeals
(Full Name)
Section to conduct an Administrative Review of: (Select one)
Revocation or suspension of my Concealed Carry License # _______________________ (OR)
Denial of my Concealed Carry License Application # _________________________
I was notified of this revocation/denial/suspension by mail on _________________.
PERSONAL STATEMENT: Describe in your own words the reason for your appeal.
CORRECTIVE ACTION: Include a description of the information you are providing to correct your application or
criminal history record. You may attach additional documents as needed.
I understand that pursuant to 20 ILAC 1231.170, this review must be requested in writing within 60 days of
notification of the revocation/suspension/denial of my Concealed Carry License/Application. If I do not
request a review within the 60-day time limit, I understand I will be required to re-apply for a Concealed Carry
License. I also understand my request will not be processed until all requested documentation is received by
the Illinois State Police, Firearms Services Bureau, Appeals Unit.
Printed Name: _______________________________________ Date of Birth: ____________________________
Signature ___________________________________________ Date: ___________________________________
This form must be completed, signed, dated, and returned to:
Firearms Services Bureau
Attn: CCL Appeals
801 S. 7th St., Suite 400-M
Springfield, IL 62703
OR
[email protected]
*** FOR INTERNAL USE ONLY ***
DATE RECEIVED: ______________
REVIEWED BY: ________________
ADDITIONAL DOCUMENTS NEEDED:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
DISPOSITION:
Informal Review Granted
Informal Review Denied
Relief Granted – Director
Relief Denied – Director
Administrative Hearing
DATE: ________________
DATE: ________________
DATE: ________________
DATE: ________________
DATE: ________________

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