In the state of Connecticut, precious metal dealers are obliged to adhere to stringent reporting protocols to ensure the legality of their transactions. The Connecticut FPD 124 form serves as a critical instrument in this regulatory framework, mandating that dealers submit detailed weekly reports to the Fairfield Police Department. This document captures comprehensive business information, encompassing the dealer’s name, address, and the specifics of each transaction conducted within the week, including the date, time, and ticket number for both pledged and sold items. Furthermore, it requires an exhaustive description of the traded precious items, incorporating brand name, make, serial number, model number, and distinctive markings or engravings. It also necessitates detailed records of the seller or pledger, necessitating verifiable identification data and a description that includes race, date of birth, height, weight, eye, and hair color. Failure to comply with these requirements by not submitting the form as mandated can lead to the revocation of the dealer's license, illustrating the form's pivotal role in the enforcement of Chapter 409, Section 21-11 of the Connecticut General Statutes. This process, aimed at curbing illegal activities and enhancing transparency in precious metal transactions, underscores the importance of meticulous record-keeping and adherence to legal standards within the industry.
| Question | Answer |
|---|---|
| Form Name | Connecticut Form Fpd 124 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | pawnsheet pawn sheeg form |
FAIRFIELD POLICE
100 Reef Road, Fairfield, CT 06824 (203)
PRECIOUS METAL DEALERS WEEKLY REPORT FORM
THESE REPORTS MUST BE SUBMITTED TO THE FAIRFIELD POLICE DEPARTMENT WEEKLY.
FAILURE TO DO SO COULD RESULT IN THE DEALERS LICENSE BEING REVOKED.
BUSINESS INFORMATION
REPORT FOR WEEK ENDING:
PAGE:
OF
NAME:
OWNER'S NAME:
ADDRESS: # STREET
FAIRFIELD, CT
TELEPHONE #:
INSTRUCTIONS
ALL INFORMATION ON THIS FORM SHALL BE EITHER TYPED OR LEGIBLY PRINTED. THE FRONT AND REAR OF THIS SHEET WILL BE FILLED OUT, SIGNED, AND NOTARIZED (SEAL REQUIRED). IF MORE THAN ONE PAGE IS UTILIZED FOR A WEEK, THE PAGES WILL BE CONSECUTIVELY NUMBERED. COMPLETE ONLY THE TOP SECTION OF PAGE ONE AND COMPLETELY FILL IN PAGE 2 OF ANY ADDITIONAL SHEETS.
On the reverse side of this form each and every transaction will be listed. This will include the date and time of the transaction, the ticket/receipt number (indicating pledge or sold), a complete description of the item or article (to include brand name, make, serial number, model number, and any other definitive markings or engravings), the Seller/Pledger's full name and residence as well as verifiable identification (such as motor vehicle operator's license) and a description of the Seller/ Pledger. The description SHALL include Race (W=White, B=Black, H=Hispanic, A=Asian, O=Other), date of birth, height, weight, eye color and hair color.
NOTARIZATION
The information contained on this form represents the total transactions completed by me for the week ending, as indicated above, in compliance with Chapter 409, Section
SIGNATURE OF DEALER / PAWNSHOP OPERATOR |
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STATE OF CONNECTICUT, COUNTY OFSS.
Subscribed to and sworn before me on this ________ day of ___________________ 20_______.
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rev.11/08 |
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