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

Steps

  1. 1. Step One
  2. 2. To Be Completed by Government Official
  3. 3. Consent for Mental Health Records Search
  4. 4. Part Two (to be completed by County Adjuster's Office, mental health institution, and/or doctor)
  5. 5. Part Three (To be completed by authorized official or doctor only if applicant has record of admission, commitment or treatment at a hospital, mental institution or sanitarium for a mental disorder.)
  6. 6. Authorization for Release of Information
  • Step One

    1. This form is prescribed by the Superintendent for use by applicant for Firearms Purchaser I.D. Cards and Handgun Purchase Permits. Any alteration to this form is expressly forbidden.

    2. Check Appropriate Block(s)

    3. Name

    4. Last (If female, include maiden.), First, Middle

    5. Number and Street, City, State, Zip

    6. City, State, County

    7. (Marks, Scars, Tattoos)

    8. (11) U.S. Citizen

    9. (16) 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?

    10. (17) Are you subject to any court order issued pursuant to domestic violence?

    11. (18) Have you ever been adjudged a juvenile delinquent?

    12. (19) 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?

    13. (20) 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?

    14. (21) Do you suffer from a physical defect or disease?

    15. (22) If the answer to question 21 is yes, does this make it unsafe for you to handle firearms?

    16. (23) Are you an alcoholic?

    17. (24) 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?

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

    19. (26) 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?

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

    21. (28) 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 of this State, or which seeks to deny others their rights under the Constitution of either the United States or the State of New Jersey?

    22. Electronic Signature Agreement

      I hereby certify that the answers given on this application are complete, true and correct in every particular. I realize that if any of the foregoing answers made by me are false, I am subject to punishment.

    23. (The disclosure of my social security number is voluntary. Without this number, the processing of my application may be delayed. This number is considered confidential.)

    24. Falsification of this form is a crime of the third degree as provided in NJS 2C:39-10c.

    25. A non-refundable fee of $5 for a Firearms Purchaser Identification Card (Initial Firearms Purchaser ID card only) and/or $2 for each Permit to Purchase a Handgun, payable to the Superintendent of State Police or the Chief of Police in the municipality in which you reside must accompany this application.