Pdcs 4406M Form – Fill Out and Use This PDF

The PDCS 4406M form is a comprehensive questionnaire provided by the Suffolk County Police Department and is required from all individuals applying for a pistol license. It covers personal information, physical description, employment history, previous residences, criminal history, mental health status, and more, ensuring that the applicant meets all criteria for owning a pistol in Suffolk County. If you're considering applying for a pistol license and need to fill out the PDCS 4406M form, click the button below to get started.

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Pdcs 4406M Form PDF Details

In the realm of lawful firearms ownership, accurate and comprehensive documentation is paramount, especially within jurisdictions that maintain stringent control over gun licensing. The PDCS 4406M form, utilized by the Suffolk County Police Department, exemplifies such rigorous vetting processes. This questionnaire, a pivotal document for pistol license applicants, spans a broad spectrum of inquiries designed to assess the suitability of individuals seeking firearm possession. It encompasses basic identification details, including name and social security number, as well as more nuanced information such as employment history, past residences, and even character references. Moreover, the form delves into areas concerning past criminal history, mental health status, substance use, and the presence of firearms in the applicant's household. The inclusion of questions regarding disapprovals or revocations of previous license applications underlines the thoroughness with which Suffolk County approaches firearm licensing. Applicants are also required to swear to the truthfulness of their responses before a notary, adding a legal certitude to the process. This form not only serves as a means to vet potential licensees but also as a testament to the prevailing dedication to community safety and responsible gun ownership.

Question	Answer
Form Name	Pdcs 4406M Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	pistol permit suffolk county, suffolk county ny pistol permit application, suffolk pistol permit, suffolk county pistol permit

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POLICE DEPARTMENT COUNTY OF SUFFOLK

ACCREDITED LAW ENFORCEMENT AGENCY

PISTOL LICENSE APPLICANT QUESTIONNAIRE

PDCS 4406m

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)

14.

WEIGHT (POUNDS)

15. RACE

16.

HAIR COLOR

17.

EYE COLOR

18.

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

YES

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)

PAGE 2 OF 2

27.LIST ALL PRIOR PLACES OF RESIDENCE (INCLUDE STREET ADDRESS, CITY, STATE, AND ZIP CODE)

28. Spouse/ Domestic Partner Name:

D.O.B.:

Telephone #: Cell Phone #:

29. If Female, Your Maiden Name and all Previous Married Names:

30. If Married, Your Spouse’s Maiden Name:

31. Mother’s Maiden Name (Last, First):

32.Father’s Name (Last, First):

33.Nicknames or Aliases (Applicant):

34.Next of Kin (include person’s Name, Address, Phone# and relation to applicant):

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 arrested for 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?		YES		NO	

	Have you or any member of your household ever been admitted to any mental institution or hospital, public or private?		YES		NO	

46.	Do you now or have you ever tried, used, possessed or sold marijuana or its derivatives, narcotics, controlled substances,		YES		NO
46.			YES		NO	
	tranquilizers, or anti-depressant medication?
	If any of these substances were prescribed by a doctor, provide doctor’s name, address, and phone number.

47.	Have you ever been denied appointment to a civil service position; federal, state, or local?		YES		NO	


48.	Have you ever served in the military? YES  NO 	If yes, have you ever been the subject of military discipline?	YES		NO	


49.	Have you ever had any license, including, but not limited to, a driver’s license, pistol license, or liquor license issued by		YES		NO	
	any agency denied, revoked, cancelled or suspended?

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 8½” 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-4406m

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

How to Edit Pdcs 4406M Form Online for Free

You can easily create documents using our PDF editor. Enhancing the suffolk county pistol license form document is effortless if you consider the following actions:

Step 1: Click the "Get Form Now" button to begin the process.

Step 2: At the moment you are on the document editing page. You can modify and add text to the file, highlight specified content, cross or check specific words, insert images, sign it, delete unneeded fields, or eliminate them completely.

All of the following sections are what you are going to fill out to obtain the ready PDF document.

suffolk county pistol permit application empty fields to complete

Write the details in DATE, POLICE AGENCY, CHARGE, DISPOSITION, COURT DATE, List all handguns in your, MANUFACTURER, PISTOL OR REV, SERIAL, MODEL, PROPERTY OF, Current Employer, Employer Address, Occupation, and Nature of Employment.

Filling out suffolk county pistol permit application part 2

Write the main particulars in PRESENT ADDRESS include House, if different, Address City State New York Zip, Home Telephone, Alternate Cell Telephone, and Mailing Address box.

Filling out suffolk county pistol permit application step 3

The List all prior places of, LIST ALL PRIOR PLACES OF, Spouse Domestic Partner Name, DOB, Telephone Cell Phone, If Female Your Maiden Name and, If Married Your Spouses Maiden, Mothers Maiden Name Last First, Fathers Name Last First, Nicknames or Aliases Applicant, Next of Kin include persons Name, Name and address of person who, resident but does not need to, Name Address, and Telephone segment should be applied to record the rights or responsibilities of each party.

Completing suffolk county pistol permit application step 4

Prepare the form by reviewing the following fields: Have you ever undergone treatment, YES, Have you ever suffered any mental, YES NO, Have you ever had a pistol, such license revoked or cancelled, Do you have any physical, YES, YES, Have you ever been charged, YES NO, Has anyone in your household been, Have you or any member of your, but not limited to depression, and Have you or any member of your.

suffolk county pistol permit application Have you ever undergone treatment, YES, Have you ever suffered any mental, YES NO, Have you ever had a pistol, such license revoked or cancelled, Do you have any physical, YES, YES, Have you ever been charged, YES NO, Has anyone in your household been, Have you or any member of your, but not limited to depression, and Have you or any member of your fields to fill out

Step 3: Select the "Done" button. So now, you may transfer your PDF file - upload it to your electronic device or send it via email.

Step 4: Make duplicates of the file - it may help you stay away from potential troubles. And don't get worried - we are not meant to share or see your information.

Pdcs 4406M Form – Fill Out and Use This PDF

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