Pdcs 4406K Form PDF Details

In the quest for obtaining a pistol license within Suffolk County, the PDCS 4406K form stands as a critical document, unfolding as a comprehensive applicant questionnaire under the oversight of the accredited Suffolk County Police Department. This intricate form spans two pages, covering a broad spectrum of personal, employment, and residence history detail requirements, in addition to specific inquiries pertinent to firearm possession. Applicants encounter a structured layout that prompts information ranging from basic identifiers like name and Social Security number to more nuanced data concerning physical description, prior criminal records, employment history, and character references. The questionnaire delves deeper into matters of mental health, substance use, and even familial ties that could influence the licensing decision. Notably, the form mandates disclosures regarding any past interactions with the law, spanning from traffic infractions to more severe charges, alongside queries on potential mental health evaluations and treatments. Furthermore, the PDCS 4406K form ensures thorough vetting by soliciting information on any prior license disapprovals, revocations, or related circumstances that could bear on one's eligibility for a pistol license. Thus, Suffolk County's approach to pistol license applications underscores a commitment to public safety by meticulously assessing each applicant's background, character, and justifications for gun ownership, as encapsulated within the PDCS 4406K form.

QuestionAnswer
Form NamePdcs 4406K Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescounty pistol license applicant, ny suffolk pistol form get, pistol license renewal application pdcs 4413h, pistol permit application

Form Preview Example

POLICE DEPARTMENT COUNTY OF SUFFOLK

ACCREDITED LAW ENFORCEMENT AGENCY

PISTOL LICENSE APPLICANT QUESTIONNAIRE

PDCS 4406k

PAGE 1 of 2

 

 

 

 

 

 

 

 

 

 

1.

Last Name:

7.

Date of Birth:

Male

Female

 

 

 

 

 

 

 

 

 

 

2.

First Name:

8.

City of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Middle Name:

9.

State of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Suffix:

10. Citizenship (Country):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Social Security #:

11.

Marital Status:

 

 

 

 

 

 

 

 

 

 

6.

Alien Registration # (if applicable):

12.

Type of License You Are Applying For: (see Instructions Page 1)

 

 

 

 

 

 

 

 

 

 

PHYSICAL DESCRIPTIVE DATA:

13.HEIGHT (FEET/INCHES)

16. HAIR COLOR

14.WEIGHT (POUNDS)

17. EYE COLOR

15. RACE

18.Have you ever been arrested, summoned, charged or indicted anywhere for any offense, including DWI (except traffic infractions)?

YES NO

If yes, furnish the following information:

DATE

POLICE AGENCY

CHARGE

DISPOSITION

COURT & DATE

19. List all handguns in your possession (if none, so indicate)

 

MANUFACTURER

PISTOL

CALIBER

SERIAL #

MODEL

 

PROPERTY OF

 

 

OR REV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Current Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

Employer Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.

Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

Nature of Employment

 

 

 

 

24. Business Phone

 

 

 

 

 

 

 

 

 

 

25.List all prior places of employment (include business name, address, nature of business and phone #)

26.PRESENT ADDRESS: include House #, City, Village, Town, State (if other than New York), Zip Code, and Telephone # (include mailing address if different)

Address

 

City

State: New York Zip Code

 

 

 

 

 

 

 

 

 

 

 

Home Telephone #

 

 

Alternate/ Cell Telephone #

 

 

 

 

Mailing Address

POLICE DEPARTMENT COUNTY OF SUFFOLK

PISTOL LICENSE APPLICANT QUESTIONNAIRE (CONTINUED)

27.

List all prior places of residence (include street address, city, state, and zip code)

PDCS-4406k PAGE 2 OF 2

 

 

 

 

28.

Spouse/ Domestic Partner Name:

 

D.O.B :

 

 

Telephone #:

 

 

 

 

 

 

Cell Phone #:

 

 

 

 

 

 

 

29.

If Female, Your Maiden Name:

 

 

30. If Male, Your Wife's Maiden Name:

 

 

 

 

 

31. Mother's Maiden Name:

32. Father's Name:

 

 

33. Nicknames or Aliases (Applicant):

 

 

 

 

 

 

 

34.Next of Kin (include person's Name, Address, and Phone #):

35.Name and address of person who will safeguard pistol (s) and notify the Pistol Licensing Bureau in case of Applicant's death or disability. (should be a Suffolk County resident, but does not need to possess a pistol license)

Name:

 

Telephone:

Address:

 

 

36.Give four (4) character references who, by their signature, attest to your good moral character - list references alphabetically and print clearly. Each reference must personally sign form. (see qualifications in instructions)

LAST, FIRST, MI

D.O.B.

STREET ADDRESS

CITY, TOWN

TELEPHONE

SIGNATURE

37. A license is required for the following reason: (see instructions, page 1)

38. Have you ever been terminated/discharged from any employment or the armed forces for cause?

YES

NO

 

 

 

39. Have you ever undergone treatment for alcoholism or drug use?

YES

NO

 

 

 

 

40.

Have you ever suffered any mental illness, or been confined to any hospital, public or private institution, for mental illness?

YES

NO

 

 

 

 

41.

Have you ever had a pistol license, dealer's license, gunsmith license, or any application for such a license disapproved, or had

 

 

 

such license revoked or cancelled?

YES

NO

 

 

 

42. Do you have any physical condition which could interfere with the safe and proper use of a handgun?

YES

NO

 

 

 

43. Have you ever been charged, petitioned against, a respondent or otherwise been a subject of a proceeding in Family Court?

YES

NO

 

 

 

 

44.

Has anyone in your household been convicted of a felony or serious offense?

YES

NO

 

 

45.

Have you or any member of your household ever been evaluated or treated as a result of any mental health issues including, but not limited to depression?

 

Have you or any member of your household ever been admitted to any mental institution or hospital, public or private?

YES

NO

 

 

46.

Have you ever used or still use marijuana or its derivatives, narcotics, tranquilizers, or anti-depressant medication? If any of these substances were prescribed

 

by a doctor, provide doctor's name, address, and phone number.

YES

NO

 

 

 

 

47.

Have you ever been denied appointment to a civil service position; federal, state, or local?

YES

NO

 

 

 

 

48.

Have you been the subject of military disciplinary action?

YES

NO

 

 

 

 

49.

Have you ever had any license (i.e. driver's or liquor) issued by any agency denied, revoked, cancelled or suspended?

YES

NO

 

 

 

 

50.

Have you received a traffic summons, or been arrested or convicted for any traffic infraction in the last five (5) years?

 

 

 

If yes, list the date(s), charge(s), police agency, court, and disposition.

YES

NO

51.If you have answered 'yes' to any of the above (questions 38 through 50) and require additional space, submit a separate detailed, notarized explanation on 8 1/2'' x 11" sized paper.

STATE OF NEW YORK

 

COUNTY OF SUFFOLK I

being duly sworn, depose and say that I am the above

named person and I have signed the foregoing statement.

I have personally read and answered all questions therein and I do solemnly swear that every answer is full, true, and correct in every respect.

Sworn to before me this

 

 

 

Day of

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTARY STAMP

SIGNATURE OF APPLICANT

 

 

 

SIGNATURE OF NOTARY/WITNESS

POLICE DEPARTMENT COUNTY OF SUFFOLK

CONTINUATION PAGE - IF ADDITIONAL SPACE IS REQUIRED

PDCS-4406k

STATE OF NEW YORK

 

COUNTY OF SUFFOLK I

being duly sworn, depose and say that I am the above

named person and I have signed the foregoing statement.

I have personally read and answered all questions therein and I do solemnly swear that every answer is full, true, and correct in every respect.

Sworn to before me this

Day of

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTARY STAMP

SIGNATURE OF APPLICANT

 

 

 

SIGNATURE OF NOTARY/WITNESS

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suffolk county pistol permit application writing process outlined (portion 1)

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Home Telephone, Zip Code, and City of suffolk county pistol permit application

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Part # 4 in filling out suffolk county pistol permit application

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