Broome Count Pistol Permit – Fill Out and Use This PDF

155 Lt.VanWinkle Dr.

Binghamton, New York 13905

PISTOL PERMIT

REQUIREMENTS AND INSTRUCTIONS

License Requirements

1.To apply, you must be a Broome County Resident.

2.You must provide four (4) character references who must be Broome County residents and who have known you for at least three (3) years. References cannot be relatives. Questions regarding references should be directed to Sheriff’s Pistol Permit Office 778-2113.

3.If you have lived in Broome County for less than three (3) years, you must also submit three (3) additional notarized character references from persons who live in the state or county where you previously lived and who have known you for a least three (3) years.

4.You must be at least 21 years of age to qualify for a permit and 21 years of age to purchase a gun from a dealer.

License Instructions

1.Complete legibly, in ink, two (2) copies of the permit application, one (1) proof of character form, one (1) Department of Mental Health inquiry and one (1) Request for Restricted Permit form (to be completed and notarized for those individuals requesting a pistol permit for hunting and target shooting only) If you are requesting a nonrestrictive permit, please submit a letter to the Judge along with your application explaining the reason you should be issued a nonrestrictive permit.

2.If you currently own a pistol (s) and intend to possess it in Broome County, please list the gun information in the space provided on the reverse side of the application.

3.Type or print in BLACK INK ONLY. No carbon copies please.

4.Present four (4) face photographs, taken within 30 days that are “PASSPORT SIZE” (2” BY 2”). No snapshots or machine photos please. Black and White or color acceptable.

5.Applications must be notarized (4 places) BEFORE you submit them for processing, also the request sheet for a pistol permit must be notarized. If your address or place of employment is changed after the application is turned in for processing, please notify the Pistol Permit Office at 778-2113.

Office of the Sheriff

LICENSE INSTRUCTIONS cont’d

THE SHERIFF OFFICE FINGERPRINTS ON MONDAY THRU FRIDAY. 9:00AM TO 2:00PM. THERE IS NO ADDITIONAL CHARGE FOR FINGERPRINTING.

6.If you lived in another state and own a pistol (s), you must submit proof of ownership with you application.

7.Unregistered pistols in your possession MUST be turned in to your local law enforcement officials, until the permit is issued.

8.Questions not truthfully answered may be cause for denial of your application by the Judge.

9.Bring all completed documents and $140.00 cash or cashiers check or money orders. NO PERSONAL CHECKS WILL BE ACCEPTED Cashiers checks or money orders must be made payable to B.C.

OMB. Bring all documents to Broome County Sheriff’s Office ID Division. Broome County Sheriff’s Office

155 Lt. VanWinkle Drive

Binghamton, New York 13905

***(OFFICE HOURS FOR PROCESSING A NEW PISTOL PERMIT IS

MONDAY THRU FRIDAY 9:00 TO 2:00PM ONLY)***

10.Processing of your pistol permit application after filing with the Permit Office can take five to six months.

11.Any omission of fact or any false statement will be sufficient cause to deny this application.

12.If you are arrested or convicted for any offense after you submit your application you must immediately disclose this information to the pistol permit clerk. If you fail to do so, your application may be denied.

13.For further information, you may call the Broome County Pistol Permit Office at 778-2113, between 8:30am and 4:00pm Monday thru Friday.

14.Upon completion of the process, you will be notified immediately by this office that your completed Pistol License may be picked up at your convenience.

Office of the Sheriff

155 Lt. VanWinkle Drive

Pistol Permit Division

Binghamton, New York 13905

BUREAU OF CLINICAL INFORMATION

Attention: CENTRAL FILES UNIT

NYS OFFICE OF MENTAL HEALTH

In order that we may comply with legislation of the issuance of pistol permits, we would appreciate information concerning the person listed below:

1)Name: ____________________________________________________

2)Alias: ____________________________________________________

3)Address: __________________________________________________

__________________________________________________

4)Sex: ______________________________________________________

5)Date of Birth: _______________________________________________

6)Social Security #_____________________________________________

Date Transmitted: ____________________________

OFFICE OF THE SHERIFF

155 Lt. Van Winkle Drive

Binghamton, New York 13905

ARREST AFFIDAVIT

Your pistol license application specifically states:

“Have you ever been arrested or indicted anyw here for any offense, including D/ W / I/ (Except Traffic

Infractions)?”

You MUST state any and all, including sealed arrests regardless of whether or not you were convicted.

An investigation will take place to verify the information provided.

ANYOMISSION OF FACT OR ANYFALSE STATEMENT WILLBE SUFFICIENT CAUSE TO DENYTHIS

APPLICATION AND CONSTITUTES A CRIME PUNISHABLE BYFINE, IMPRISONMENT OR BOTH.

Any false statements made herein is a class A misdemeanor pursuant to section 210.45 of the New York State Penal Law.

Please print the following information:

Full Name: ___________________________________________________________________

Physical

Address: _____________________________________________________________________

________________________________________

Applicant’s Signature

Signed and sworn before me

this ______ day of _____________________ , 20____

_________________________________________

NOTARYPUBLIC

Applicant’s name: ________________________________________________________

LASTFIRSTMIDDLE

Home address: ___________________________________________________________

___________________________________________________________

List all previous addresses: _________________________________________________

________________________________________________________________________

________________________________________________________________________

Employers name & address: ________________________________________________

________________________________________________________________________

Business telephone number: (_____) ____________

Your current supervisor’s name and telephone number: __________________ ________

_______________________________________________________________________

Your closest neighbor’s name and address: ____________________________________

_______________________________________________________________________

Your birthplace: _________________________________________________________

{RETIRED OR UNEMPLOYED, LIST YOUR LAST EMPLOYER’S NAME AND ADDRESS}

Applicants Name: _______________ ________________________________________ ______________

LASTFIRSTMIDDLE

Address:______________________________________________________________________________

CITYSTATEZIP CODE

CHARACTER REFERENCES – NO RELATIVES

Name: _________________________ ______________________ Maiden Name: ________________

Address: ____________________________________________________________________________

*************************************************************************************

Name: _________________________ ______________________ Maiden Name: ________________

Address: ____________________________________________________________________________

*************************************************************************************

Name: _________________________ ______________________ Maiden Name: ________________

Address: ____________________________________________________________________________

*************************************************************************************

Name: _________________________ ______________________ Maiden Name: ________________

Address: ____________________________________________________________________________

NOTICE TO APPLICANT:

YOUR CHARACTER REFERENCES WILL BE INVESTIGATED

FOR A PAST CRIMINAL HISTORY.

A CHARACTER REFERENCE WITH AN ARREST RECORD COULD BE

UNACCEPTABLE AND DELAY YOUR APPLICATION.

Office of the Sheriff

Pistol Permit Application

REQUEST FOR A RESTRICTED PISTOL PERMIT

Broome County , New York

I, ____________________________________________________ in support of my application

for a Restricted Pistol Permit, Represent to the Issuing Officer.

1)That I understand the Pistol Permit, if issued, will allow me to carry registered weapons for the limited purpose of hunting or target shooting only.

2)That this permit does not authorize me to possess, use or carry any firearms for any other purposes.

3)That I will carry authorized firearms only when going to, coming from and during activities related to hunting and target shooting and while enroute to or from hunting and target shooting. I will not carry or display a firearm while engaged in any unrelated activities.

4)That I will under no circumstances carry or display any firearm in any premise licensed to sell alcoholic beverages.

5)That I understand if I violate any of the above conditions of issuance, my permit is subject to suspension or revocation at the discretion of the Issuing Officer.

Sworn to before me

This ______day of _______________,20____

__________________________________________

NOTARY PUBLIC

FINGERPRINTS

SUBMITTED

ELECTRONICALLY