SIGNING THIS APPLICATION AUTHORIZES THE WASHINGTON HEALTH CARE AUTHORITY, AS WELL AS MENTAL-HEALTH INSTITUTIONS AND OTHER HEALTH-CARE FACILITIES, TO RELEASE INFORMATION RELEVANT TO YOUR ELIGIBILITY FOR A CONCEALED PISTOL LICENSE TO AN INQUIRING COURT OR LAW-ENFORCEMENT AGENCY. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
CAUTION: ALTHOUGH STATE AND LOCAL LAWS DO NOT DIFFER, FEDERAL LAW AND STATE LAW ON THE POSSESSION OF FIREARMS DIFFER. IF YOU ARE PROHIBITED BY FEDERAL LAW FROM POSSESSING A FIREARM, YOU MAY BE PROSECUTED IN FEDERAL COURT. A STATE LICENSE IS NOT A DEFENSE TO FEDERAL PROSECUTION