Application Form Last Name *First Name *Suffix0 / 3Date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923Gender *MaleFemaleNY Driver’s License (or NY Non-Driver ID) No *0 / 9Race *WeightHair *Citizen of U.S.AYESNOEyes *Street Address *Apartment, suite, etc *City *State/Province *ZIP / Postal Code *Primary Phone Number *Secondary Phone Number *Email Address *Employed ByPresent OccupationNature of BusinessBusiness Address (Street number, street name, apartment number, city, state, zip code)I hereby apply for a Pistol / Revolver License to: (Check only one)Carry ConcealedPossess on PremisesPossess / Carry During EmploymentAre you a fugitive from justice? *YESNOAre you an unlawful user of or addicted to any controlled substance as defined in section 21 U.S.C. 802? *YESNOAre you an alien illegally or unlawfully in the United States? *YESNOAre you an alien admitted to the United States who does not qualify for the exceptions under 18 U.S.C. 922 (y)(2)? *YESNOHave you been discharged from the Armed Forces under dishonorable conditions? *YESNOHave you ever renounced your United States citizenship? *YESNOHave you ever suffered any mental illness? *YESNOHave you ever been involuntarily committed to a mental health facility? *YESNOHave you ever had a pistol / revolver license revoked? *YESNOAre you under any firearms suspension or ineligibility order issued pursuant to the provisions of section 530.14 of the criminal procedure law or section eight hundred forty-two-a of the family court act? *YESNOHave you had a guardian appointed for you pursuant to any provision of state law, based on a determination that as a result of marked subnormal intelligence, mental illness, incapacity, condition or disease you lack the mental capacity to contract or manage your own affairs? *YESNOAre you aware of any good cause for the denial of the license? *YESNOAre you prohibited from possessing firearms under federal law, including having been convicted in any court of a misdemeanor crime of domestic violence or being under indictment for a crime punishable by imprisonment for a term exceeding one year? *YESNOIf the answer to any of the questions above is YES, explain here:For applicants under twenty-one years of age only: Have you been honorably discharged from the United States Army, Navy, Marine Corps, Air Force or Coast Guard, or the National Guard of the State of New York?YESNOUpload Photograph Of Applicant Taken Within 30 Days *Choose FileNo file chosenDelete uploaded fileFull Face OnlyUpload Driver's License Photo *Drag and Drop (or) Choose FilesUpload a clear photo of your driverLicense (Front and back)Send Message
