DPS-67-C PDF Details

Here are some key points you should be aware of:

Personal Details: The form requires an applicant to provide their personal details such as name, date of birth, address, sex, race, height, weight, eye color, and hair color. The information is used for identification purposes.

Pistol Permit and Other IDs: Connecticut requires you to have a pistol permit or eligibility certificate number to purchase a firearm. You also need to provide details about your motor vehicle operator's license.

Misdemeanor Convictions: The form specifically asks about certain misdemeanor convictions, giving details on each relevant statute in Connecticut's general statutes. This helps the authorities determine the nature and seriousness of the offense.

Verification: All the information provided by the applicant is subject to verification from various sources like probate, civil, and criminal courts, as well as governmental agencies under state and federal law.

Certification: The applicant has to certify that all provided information is true and correct. Providing false information on the form can result in felony charges under the Connecticut General Statutes.

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

How to Edit DPS-67-C Form Online for Free

Working with PDF files online is always surprisingly easy with our PDF editor. You can fill out how to application purchase firearm here effortlessly. To make our tool better and less complicated to utilize, we consistently implement new features, with our users' suggestions in mind. Should you be looking to start, this is what it takes:

Step 1: Click the "Get Form" button at the top of this webpage to access our editor.

Step 2: Using this state-of-the-art PDF editor, you can accomplish more than merely fill in blank fields. Try all of the functions and make your docs look great with custom textual content added in, or adjust the file's original input to perfection - all backed up by an ability to insert your own images and sign it off.

It is simple to finish the document with our detailed guide! Here is what you need to do:

1. Whenever filling in the how to application purchase firearm, make certain to incorporate all of the important blank fields in the relevant section. It will help facilitate the process, making it possible for your details to be handled quickly and appropriately.

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

Step 3: Right after you have reread the information in the fields, press "Done" to finalize your FormsPal process. Get hold of the how to application purchase firearm once you subscribe to a 7-day free trial. Immediately gain access to the form in your FormsPal account page, with any modifications and adjustments all kept! FormsPal is committed to the personal privacy of our users; we ensure that all personal information coming through our editor is kept confidential.

DPS-67-C Form isn’t the one you’re looking for?

Related Documents