Firearms Purchaser Identification Card and/or Handgun Purchase Permit

Background Information

If you do not know how to answer ANY of the following questions, CONTACT YOUR LOCAL POLICE DEPARTMENT FIREARMS INVESTIGATOR for assistance. Answering these questions incorrectly may lead to CRIMINAL CHARGES, and/or the withdrawal of your application. Fees are non-refundable.

Have you ever been convicted of any domestic violence offense in any jurisdiction which involved the elements of (1) striking, kicking, shoving, or (2) purposely or attempting to or knowingly or recklessly causing bodily injury, or (3) negligently causing bodily injury to another with a deadly weapon?

Yes
No

Explain

Are you subject to any court order issued pursuant to Domestic Violence?

Yes
No

Explain

Have you ever been adjudged a juvenile delinquent?

Yes
No

List date(s), place(s) and offense(s)

Have you ever been convicted of a disorderly persons offense in New Jersey or any criminal offense in another jurisdiction where you could have been sentenced up to six months in jail that has not been expunged or sealed?

Yes
No

List date(s), place(s) and offense(s)

Have you ever been convicted of a crime in New Jersey or a criminal offense in another jurisdiction where you could have been sentenced to more than six months in jail that has not been expunged or sealed?

Yes
No

Explain how many times with date(s), place(s) and offense(s)

Do you suffer from a physical defect or disease?

Yes
No

Does this make it unsafe for you to handle firearms?

Yes
No

If not, explain.

Are you an alcoholic?

Yes
No

Have you ever been confined or committed to a mental institution or hospital for treatment or observation of a mental or psychiatric condition on a temporary, interim, or permanent basis?

Yes
No

Explain how many times, list of institutions or hospitals name and locations, and dates of confinement or commitment.

Are you dependent upon the use of a narcotic(s) or other controlled dangerous substance(s)?

Yes
No

Have you ever been attended, treated, or observed by any doctor or psychiatrist or at any hospital or mental institution on an inpatient or outpatient basis for any mental or psychiatric condition?

Yes
No

Explain how many times, list names of doctor, psychiatrist, hospital or institution and dates of such occurrences.

Have you ever had a firearms purchaser identification card, permit to purchase a handgun or any other firearms license or application refused or revoked in New Jersey or any other state?

Yes
No

Explain

Are you presently, or have you ever been a member of any organization which advocates or approves the commission of acts of force and violence, either to overthrow the Government of the United States or which seeks to deny others their rights under the Constitution of United States or the State of New Jersey?

Yes
No

List names and address of organization(s)

Application for Firearms Purchaser Identification Card and/or Handgun Purchase Permit