DPS-67-C PDF Details

In the process of purchasing a firearm, individuals in certain jurisdictions are required to complete specific forms that authenticate their eligibility under state and federal laws. The DPS 67 C form, an "Application to Purchase a Firearm", is an essential document for buyers within the scope of Connecticut statutes, particularly Sections 29-33 and 29-37a. This form is meticulous in its requirements, requesting comprehensive personal details such as name, date of birth, address, and more intimate data including sex, race, and even physical characteristics like height, weight, eye, and hair color. Significantly, it doesn't overlook the legal and mental health background of the applicant, asking pointed questions about past felony convictions, misdemeanor charges related to domestic violence, any active restraining orders, and specific inquiries regarding mental health hospitalizations and evaluations. Furthermore, it touches upon prior denials of firearm purchases and examines any convictions under specific misdemeanor categories. The completion of this form is a legal obligation, necessitating honesty and accuracy, as misinformation could lead to severe legal consequences. It is designed not only to comply with statutory requirements but also to ensure that firearms do not fall into the hands of individuals who, under the law, are deemed unfit to possess them. The form's thoroughness exemplifies the intricate balance between an individual's right to purchase firearms and the community's need for safety and security, underscored by the certification process that requires signatures from both the purchaser and the seller, ensuring a transparent transaction.

QuestionAnswer
Form Name DPS-67-C
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names dps 67, dps 67 c pdf, application to purchase firearm

Form Preview Example

APPLICATION TO PURCHASE A FIREARM – Pursuant to C.G.S. §§ 29-33 and 29-37a

 

 

 

 

 

WEAPON TYPE:

HANDGUN

LONG GUN OTHER

SALE AUTHORIZATION NUMBER(S)

 

 

Name: (Last, First, Middle)

 

 

 

 

 

Date of Birth: (MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

 

Address: Include number, street, town, state and zip (Post Office boxes not accepted)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex:

 

Race:

 

Height:

 

Weight:

 

Eye Color:

Hair Color:

 

 

 

 

 

 

 

 

 

 

Social Security Number:(optional, but will help

Country of Citizenship: (required)

 

ICE Number: (if applicable)

 

prevent misidentification)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pistol Permit Number/Eligibility Certificate Number: (required)

 

 

 

Expiration Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

Police Identification Number:

 

 

 

Agency Name:

 

 

 

 

 

 

 

 

 

 

 

Motor Vehicle Operator’s License Number: (required)

 

State:

 

Expiration Date: (MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Have you been convicted of a felony?

b. Have you ever been convicted of a misdemeanor crime of domestic/family violence?

c. Are you the subject of an active restraining or protective order issued by a court, after notice and an opportunity to be heard has been provided to you, in a case involving the use, attempted use or threatened use of physical force against another person?

Yes No

Yes No

Yes No

d. Have you ever been confined to a hospital for persons with psychiatric disability (C.G.S. § 17a-495) within the preceding sixty (60) months

by order of a Probate Court?

Yes No

e. Have you been voluntarily admitted to a hospital for persons with psychiatric disabilities, within the preceding six (6) months for

 

reasons other than solely for alcohol or drug dependence?

 

 

Yes

f. Have you been discharged from custody within the preceding twenty (20) years after having been found not

 

guilty of a crime by reason of mental disease or defect pursuant to Connecticut General Statutes Section 53a-13?

Yes

g. Are you the subject of a court issued risk warrant to seize firearms pursuant to C.G.S. § 29-38c(d)?

Yes

h. Have you ever had an application to purchase a firearm denied in any other State?

 

 

Yes

If so, Where

 

When?

 

Reason for denial?

 

 

i. Have you ever been convicted of any of the following misdemeanors?

 

 

Yes

If yes, check all that apply.

 

 

 

 

 

No

No

No

No

No

Illegal possession of controlled or hallucinogenic substances (C.G.S. § 21a-279)

Assault of an elderly, blind, disabled or pregnant person or a person with intellectual disability in the 3rd (C.G.S. § 53a-61a)

Criminally negligent homicide (C.G.S. § 53a-58)

Unlawful restraint 2nd (C.G.S. § 53a-96)

Assault in the 3rd (C.G.S. § 53a-61)

Riot 1st (C.G.S. § 53a-175)

Threatening 2nd (C.G.S. § 53a-62

Riot 2nd (C.G.S. § 53a-176)

Reckless endangerment 1st (C.G.S. § 53a-63)

Inciting to riot (C.G.S. § 53a-178)

 

Stalking 2nd (C.G.S. § 53a-181d)

Information provided on this application is subject to verification from sources including probate, civil, and criminal courts as well as governmental agencies pursuant to State and Federal Law.

I CERTIFY THAT THE ABOVE ANSWERS ARE TRUE AND CORRECT. I UNDERSTAND THAT PROVIDING FALSE INFORMATION ON THIS DOCUMENT IS A VIOLATION OF CONNECTICUT GENERAL STATUTES SECTIONS 29-34 AND/OR 29-37e AND CONSTITUTES A FELONY.

SIGNATURE OF PURCHASER

 

 

 

DATE

I UNDERSTAND THAT A PERSON WHO ANSWERS, “YES” TO QUESTIONS A-G IS PROHIBITED FROM PURCHASING A FIREARM. THOSE

APPLICANT’S ANSWERING IN THE AFFIRMATIVE TO QUESTIONS H AND I, MAY BE PROHIBITED UPON COMPLETION OF A BACKGROUND

CHECK.

 

 

 

 

 

 

 

 

 

SIGNATURE OF SALESPERSON

 

DEALER NAME, IF APPLICABLE

 

DATE

THIS FORM MUST BE FILLED OUT COMPLETELY AND LEGIBLY BY THE SELLER AND PURCHASER

DPS-67-C (Rev. 03/11/16-Previous editions are obsolete) An Affirmative Action/Equal Employment Opportunity Employer

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Part number 1 of submitting dps 67 c form

2. Just after this part is done, go on to type in the applicable information in these: a Have you been convicted of a, by order of a Probate Court, e Have you been voluntarily, Yes No, h Have you ever had an application, When, Yes No, Reason for denial, Yes No, Illegal possession of controlled, Unlawful restraint nd CGS a Riot, and Information provided on this.

Step number 2 of filling out dps 67 c form

Those who use this document often make errors when filling out Yes No in this part. Make sure you re-examine whatever you type in right here.

3. This 3rd section is considered pretty straightforward, I UNDERSTAND THAT A PERSON WHO, DEALER NAME IF APPLICABLE, DATE, DPSC Rev Previous editions are, and THIS FORM MUST BE FILLED OUT - all of these blanks is required to be filled out here.

The right way to complete dps 67 c form step 3

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