§ 54-77. Contents of application.

(a)

The police department shall prepare a questionnaire requiring pertinent information regarding the physical description, identity, and background of each applicant for a permit including, but not limited to the following:

(1)

Name and social security number of individual;

(2)

Date of birth;

(3)

Driver's license number;

(4)

Race;

(5)

Sex;

(6)

Residential address and telephone number;

(7)

Business address and telephone number;

(8)

Height and weight;

(9)

Hair and eye color;

(10)

Name and address of the organization represented;

(11)

Name, address, and telephone number of his immediate supervisor in the organization; and

(12)

A list of any pleas of guilty, convictions, or sentences of probation entered against the applicant in regard to any offenses other than minor traffic violations.

(b)

The questionnaire form shall also bear the following statement: "O.C.G.A. § 16-10-20 provides it is a felony to knowingly and willfully make a false, fictitious, or fraudulent statement or representation in any matter within the jurisdiction of any department or agency of the government of any county of this state."

(Code 1983, § 33-7-13)