W. Va. Code R. agency 58, tit. 58, ser. 58-19, app A
WEST VIRGINIA DIVISION OF NATURAL RESOURCES
APPLICATION FOR A GUN REPAIR SHOP EXEMPTION
Name and Address of Operator:
Business Name and Address: _
County:
WV Business License No:_________ Federal License No:
Location of nearest pistol/rifle range is_______ miles from the premises.
Name, address, and telephone number of each head of household residing within five hundred feet of the test firing site:
Name, address, and telephone number of any schoolhouse located within four hundred feet of the test firing site:
Name, address, and telephone number of any church located within four hundred feet of the test firing site:
The Applicant understands and agrees to comply with the provisions of West Virginia, Division of Natural Resources rule "Gun Repair Shop Exemptions" 58 CSR 20.
Date:_ Signature of Applicant:_
W. Va. Code R. agency 58, tit. 58, ser. 58-19, app A