STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Special Licensing and Firearms Unit
PISTOL PERMIT/ELIGIBILITY CERTIFICATE APPLICATION
(Pursuant to C.G.S. §§ 29-28 et. seq., 29-36 et. seq., and 53a-217 et. seq.)
Before completing this application, it is suggested that you review the Connecticut General Statutes pertaining to
firearms. These can be accessed on the Internet at www.cga.ct.gov or through your local library.
Type of Permit Requested:
Check Box:

60 Day Temporary State Pistol Permit

Non-Resident State Pistol Permit

Eligibility Certificate to Purchase Pistols or Revolvers

Eligibility Certificate to Purchase Long Guns
Instructions:
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Instructions for Non-Resident |
Instructions for Eligibility |
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Certificates to Purchase Pistols |
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Instructions for State Pistol Permits: |
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State Pistol Permits: |
or Revolvers and/or Eligibility |
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Certificates to Purchase Long |
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Guns: |
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1. Complete this form (DPS-799-C) and submit to |
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**CALL DESPP FOR PACKET** |
1. Complete this form and submit in |
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appropriate local authority (local police, resident |
You must hold a valid permit or |
person at DESPP Headquarters, |
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state trooper or first select person, as applicable) |
license to carry a pistol or revolver |
Division of State Police, located at |
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along with all of the following: |
issued by a recognized United States |
1111 Country Club Road, |
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Firearms Safety & Use Course Certificate; |
jurisdiction. |
Middletown, Connecticut along with |
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the below: |
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$70.00, fee, payable to the local authority; |
Complete this form and submit to |
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and |
DESPP, Division of State Police, pistol |
Firearms Safety & Use Course |
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Proof you are legally and lawfully in the |
permit location along with all of the |
Certificate; |
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United States (e.g., certified copy of birth |
following: |
$35.00 fee, payable to |
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certificate, U.S. passport or documentation |
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Completed State of CT and Federal |
Treasurer, State of |
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issued by I.C.E.). |
Connecticut; |
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fingerprint card with $75.00 fee and |
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Application for a State Eligibility |
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2. Submit fingerprints for a criminal history check |
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$13.25 fee, payable to Treasurer, |
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Certificate for a Pistol or |
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through a law enforcement agency. Fees include |
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State of Connecticut for criminal |
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Revolver or for Long Guns |
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a $75.00 fee and a $13.25 fee, payable at the |
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history background checks; |
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(DPS-164-C); |
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agency where the prints are taken. Fees must be |
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Firearms Safety & Use Course |
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Proof you are legally and |
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paid by separate checks. |
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Certificate; |
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lawfully in the United States |
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3. Upon approval, the local authority will issue a |
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$70.00 fee, payable to Treasurer, |
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(e.g., certified copy of birth |
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State of Connecticut; |
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Temporary State Permit to Carry Pistols and |
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certificate, U.S. passport or |
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Completed Application for State |
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Revolvers (DPS-11-C), effective for 60 days. |
documentation issued by |
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Permit to Carry Pistols and Revolvers |
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I.C.E.); and |
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4. Within the 60 day period, go to a DESPP, |
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form (DPS-46-C); |
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Proof of valid state issued photo |
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Division of State Police, pistol permit location and |
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Completed DPS-129-C signed and |
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identification card. |
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submit the following: |
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notarized and 2x2 color photograph |
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The Temporary State Permit to Carry Pistols |
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(passport style); |
2. Submit fingerprints for a criminal |
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Copy of the permit or license to carry |
history check through a law |
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and Revolvers (DPS-11-C) issued by the |
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a pistol or revolver issued to you by a |
enforcement agency. Fees include a |
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local authority; |
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recognized United States jurisdiction; |
$75.00 fee and a $13.25 fee, payable |
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A completed Application for State Permit to |
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Proof you are legally and lawfully in |
at the agency where the prints are |
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Carry Pistols and Revolvers (DPS-46-C); |
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the United States (e.g., certified copy |
taken. Fees must be paid by separate |
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$70.00 fee, payable to Treasurer, State of |
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of birth certificate, U.S. passport or |
checks. |
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Connecticut; |
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documentation issued by I.C.E.);and |
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Proof you are legally and lawfully in the |
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3. Upon approval, your photograph will |
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Proof of valid state issued photo |
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United States (e.g., certified copy of birth |
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identification card. |
be taken at DESPP and you will be |
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certificate, U.S. passport or documentation |
Out of State Pistol Permit Information: |
issued an eligibility certificate. |
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issued by I.C.E.); and |
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Proof of valid state issued photo identification |
State of Issue: _______________ |
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card. |
Expiration Date: _____________ |
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5. Upon approval, your photograph will be taken at |
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Permit Number: ______________ |
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DESPP and you will be issued a state pistol permit. |
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For Department of Emergency Services and Public Protection (DESPP), Division of State Police, pistol permit locations, access www.ct.gov/despp and follow the link to the Special Licensing and Firearms Unit or call (860) 685-8290. Note: All payments must be made with separate checks.
DPS-799-C (Rev. 03/03/21) |
An Affirmative Action/Equal Employment Opportunity Employer |
Page 1 of 4 |
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STATE OF CONNECTICUT |
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DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION |
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DIVISION OF STATE POLICE |
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Contact / Identifying Information: |
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Name of Applicant |
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Last |
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Suffix |
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First |
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Middle |
Initial |
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Provide all other names by which you have been known (Maiden name, Aliases, Nicknames, etc.) |
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(Attach additional sheet(s), if necessary) |
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Date of Birth |
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Sex |
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Height |
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Weight |
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Eye Color |
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/ |
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F |
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M |
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X |
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Ft. |
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In. |
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Lbs. |
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Brown |
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Blue |
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Black |
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Month/Day/Year |
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Green |
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Gray |
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Hazel |
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Race |
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Hair Color |
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White |
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American Indian/Alaskan Native |
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Asian/Pacific Islander |
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Brown |
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Black |
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Blonde |
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Red |
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Black |
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Unknown |
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Other |
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Gray |
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White |
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Bald |
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Place of Birth |
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, |
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Social Security Number (Optional, but will help |
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prevent misidentification) |
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City/Town |
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State |
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Country of Citizenship |
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Alien Reg. |
Number (If applicable) |
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Residential Address (List street address. Post office box numbers are not acceptable) |
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List Residential Addresses for the Last 7 Years |
(Attach additional sheet(s), if necessary) |
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*Any subsequent changes of address must be reported within 48 hours to the Special Licensing and Firearms Unit |
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1. ___________________________________________________________________________________________ |
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2. ___________________________________________________________________________________________ |
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Mailing Address (If different from current residential address above) |
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Number/Street |
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City/Town |
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Home Telephone Number |
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Motor Vehicle Operator’s License Number |
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Area Code |
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State |
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Alternate Telephone Number |
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Area Code |
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Employment History: |
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List Employers for the Last 7 Years (Provide employer’s name, address and telephone number) |
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(Attach additional sheet(s), if necessary) |
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1. __________________________________________________________________________________ |
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2. ___________________________________________________________________________________________ |
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Permit or Eligibility Certificate History: |
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Have you had a firearms permit, permit application or eligibility certificate of any kind from ANY jurisdiction in the
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United States denied, suspended or revoked? NO |
YES |
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If "YES,” provide: |
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1. |
Identify the jurisdiction which issued the denial, suspension or revocation: ___________________ |
2. |
Date of denial, suspension or revocation: _______________________________________________ |
3. |
The reason for the denial, suspension or revocation:______________________________________ |
DPS-799-C (Rev. 03/03/21) |
An Affirmative Action/Equal Employment Opportunity Employer |
Page 2 of 4 |
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Medical History:
Have you been confined in a hospital for mental illness in the past sixty (60) months by order of a Probate Court?
NO |
YES If "YES," explain: (Attach additional sheet(s), if necessary) |
Have you been discharged from custody within the past twenty years after having been found not guilty of a crime by reason of a mental disease or defect?
NO
YES
If "YES," explain: (Attach additional sheet(s), if necessary)
Have you been voluntarily admitted to a hospital for mental illness within the past six (6) months for reasons other than solely for alcohol or drug dependence? NO YES
If "YES," explain: (Attach additional sheet(s), if necessary)
Notice: DESPP herein notifies the applicant that, pursuant to C.G.S. §§ 29-28 through 29-38b, DESPP will be notified by the Department of Mental Health and Addiction Services if the applicant has been confined to a hospital for psychiatric disabilities within the preceding sixty (60) months by order of Probate Court, or if the applicant has been voluntarily admitted to a hospital for mental illness within the past six (6) months for reasons other than solely for alcohol or drug dependence.
Criminal History:
Have you ever been ARRESTED for any crime, in any jurisdiction?
NO
YES If "YES," list all arrests, indicating charges, locations, dates of arrest and dispositions. (Attach additional sheet(s), if necessary)
Notice: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to C.G.S. §§46b-146, 54-76o, or 54-142a. If your criminal records have been erased pursuant to one of these statutes, you may swear under oath that you have never been arrested. Criminal records that may be erased are records pertaining to a finding of delinquency or that a child was a member of a family with service needs (C.G.S. 46b-146), an adjudication as a youthful offender (C.G.S. 54-76o), a criminal charge that has been dismissed or nolled, a criminal charge for which the person has been found not guilty, or a conviction for which the person received an absolute pardon (C.G.S. 54- 142a).
With regard to criminal history information arising from jurisdictions other than the State of Connecticut: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to the law of the other jurisdiction. Additionally, you are not required to disclose the existence of an arrest arising from another jurisdiction if you are permitted under the law of that jurisdiction to swear under oath that you have never been arrested.
Have you ever been CONVICTED under the laws of this state, federal law or the laws of another jurisdiction?
NO
YES If "YES,” list all convictions, include charges, location, date of arrest, and disposition. (Attach additional sheet(s), if necessary)
Are you currently on probation, parole, work release, in an alcohol and/or drug treatment program or other pre-trial diversionary program or currently released on personal recognizance, a written promise to appear or a bail bond for
a pending court case? |
NO |
YES If "YES," explain. (Attach additional sheet(s), if necessary) |
Within the past five (5) years, have you been the subject of a Protective Order or Restraining Order issued by a court in a case involving the use, attempted use or threatened use of physical force against another person, regardless of
the outcome or result of any related criminal case? |
NO YES |
If “YES,” which court issued the order?
Military History:
Were you ever a member of the Armed Forces of the United States?
NO
YES (If yes, please include a copy of your DD-214) Were you ever discharged from the Armed Forces of the United States with a less than Honorable Discharge? 
NO 
YES
DPS-799-C (Rev. 03/03/21) |
An Affirmative Action/Equal Employment Opportunity Employer |
Page 3 of 4 |
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Proof of Training:
*Attach a copy of the letter or certificate attesting that you have completed a course in the safety and use of pistols and revolvers or long guns (as appropriate, depending upon which permit or certificate you are requesting), signed by the instructor of the course.
Instructor: (Check applicable box)

National Rifle Association

Department of Energy and Environmental Protection (DEEP)

Other: ___________________________________
State Instructor's Name and ID Number:_______________________________________________________
Declaration:
I understand that any false statement herein, which I do not believe to be true and which is intended to mislead a public servant in the performance of his or her official function, is punishable by law (See C.G.S. § 53a-157b). I further understand that any statement in this application that is determined to be false or inaccurate shall constitute grounds for the denial of such application. If approved before the facts are known, such approval shall be void if based on a false or inaccurate statement. My signature below attests to the accuracy, completeness and to the truth of all information supplied on this application:
I declare, under the penalties of false statement, that the answers to the above are true and correct.
Date ____________________ |
Signed |
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STATE OF |
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COUNTY OF _______________ |
Print Name |
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Subscribed and sworn to before me this ______ day of |
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20_____ |
Name:
Notary Public
My Commission Expires:
Commissioner of Superior Court
NOTICE: Appeal Process for Permits
In the event that your application for pistol permit or eligibility certificate is denied or revoked, you may notify the Board of Firearms Permit Examiners, at 165 Capitol Ave., Suite 1070, Hartford, CT 06106. Telephone: (860) 256-2947, in writing, within ninety (90) days, in order to begin your appeal process. At a hearing before the Board, you may request that your application be reconsidered or that your permit or eligibility certificate be reinstated.
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For Official Use Only: |
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Application Received: |
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FBI Sent: |
No |
Yes |
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Application Status: |
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FBI Reply: |
No |
Yes |
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Approved |
Denied |
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ICE Response: |
No |
Yes |
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Month/Day/Year |
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DMHAS: |
No |
Yes |
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SPBI: |
No |
Yes |
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(Signature and title of issuing authority) |
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Number : |
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DPS-799-C (Rev. 03/03/21) |
An Affirmative Action/Equal Employment Opportunity Employer |
Page 4 of 4 |