Form PPB-5 at a glance
What it is: PPB-5 is the State of New York Pistol / Revolver License Amendment and Semi-Automatic Rifle License Amendment.
Who signs: Licensing Officer; Signature of Licensee.
A filled-in Form PPB-5 example: a name change on a county license
How to fill out Form PPB-5, box by box
Amendment form for (check one)
Amendment form for (check one): County License OR New York State Police License.
Enter the Date.
Name, Date of Birth, Driver's License and addresses
Enter the Name, Date of Birth, Driver's License No. (or Non-Driver ID No.) and License State.
Enter the Physical Address (street, city, state, zip) and the Mailing Address (if different).
License Number and Date Issued
Enter the Pistol/Semi-Automatic Rifle License Number, Duplicate License Number and Transfer License Number, each with its Date Issued, and Transferred From and Transferred to.
Transaction Type(s) (Check all that apply)
Transaction Type(s) (Check all that apply): Acquired, Deceased, Disposed, Duplicate, Lost / Stolen Firearm, Name Change, Address Change, Revoked, Surrendered, Suspended, Transfer, E mail Address, Other.
License Type
License Type: Semi-Automatic Rifle License Add Remove; Pistol/Revolver License Add Remove; Carry Concealed, Possess on Premises, Possess/Carry During Employment.
Amend license for the following
AMEND LICENSE FOR THE FOLLOWING: 1. New Name, 2. New Physical Address, 3. New Mailing Address (If different), 4. New Email Address.
Dealer and weapons acquired from
5. Business Name of NYS Dealer Performing NICS Check.
Numbers 6, 7 and 8 DO NOT APPLY TO SEMI-AUTOMATIC RIFLES.
6. Following Weapon(s) Acquired From: (Name, Address), with Manufacturer, Pistol / Revolver / Single Shot, Model, Frame Only, Caliber(s) and Serial Number.
Weapons disposed to
7. Following Weapon(s) Disposed to: (Name, Address), with Manufacturer, Pistol / Revolver / Single Shot, Model, Frame Only, Caliber(s) and Serial Number.
Weapons lost, stolen or destroyed
8. Following Weapons(s) has been: Lost, Stolen or Destroyed, with the Law Enforcement Agency Reported To, Manufacturer, Pistol / Revolver / Single Shot, Model, Frame Only, Caliber(s) and Serial Number.
Have you been arrested and Signature of Licensee
Have you been arrested, indicted, or convicted of any criminal offense, been the subject of an order of protection, or been a patient at any mental institution since the license was issued? Yes No If Yes, give details on reverse.
Licensing Officer; Signature of Licensee.
More rules for Form PPB-5
Use the boxes if additional space is needed.
NYSID # (OFFICIAL USE ONLY).
Sources
[1] Form PPB-5 (REV 02/26), State of New York Pistol / Revolver License Amendment and Semi-Automatic Rifle License Amendment, New York State Police (the Official source link on this page).