NH Dssp260
User Manual: NH
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State of New Hampshire DEPARTMENT OF SAFETY DIVISION OF STATE POLICE NON-RESIDENT PISTOL/REVOLVER LICENSE RENEWAL APPLICANTS PLEASE COMPLETE: NH Pistol/Revolver License #: Expires See instructions on back to properly complete this form. Incomplete application will be returned. Name Mailing Address: Street Date of Application City/Town State Legal Address (If different from above): Driver’s License No. Social Security No. Telephone No. Zip (optional) (optional) FILE #: Date of Birth Place of Birth Height Hair Weight Eyes Original Renewal Sex Race Occupation: Present Employer: Employer’s Address: If you answer “Yes” to any of the following questions, you must provide complete details on the reverse side of this form. Have you ever had a permit or license to carry denied in this or any other state? Yes No Have you ever been convicted of a felony, in this or any other state, which has not been annulled? Yes No Are you an unlawful user of or addicted to any controlled substance? Yes No Have you ever been adjudicated as a mental defective by a court or committed by a court to any mental institution? Yes No Have you ever been convicted in any court of a misdemeanor crime of domestic violence? Yes No For what reason(s) do you make application to carry a pistol in New Hampshire? Name and Complete Mailing Address of three (3) references: 1. 2. 3. (NAME) (NAME) (NAME) (ADDRESS) (ADDRESS) (ADDRESS) SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION YOU MUST SIGN THIS APPLICATION: Read the following carefully before you sign. A false statement on any part of this application will be just cause for refusal of any application of any license issued under the provisions of RSA:159 and is punishable under RSA 641:3. • • • I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability and fitness to carry a pistol/revolver by employers, schools, medical/ psychiatric services, law enforcement agencies, and other individuals and organizations, to my local police chief, his or her designee, and/or authorized employees of the State of New Hampshire. I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete and made in good faith. OFFICIAL USE ONLY: SIGNATURE OF APPLICANT: DSSP260 (REV. 03/17) Date Approved Denied NON-RESIDENT APPLICATION INSTRUCTIONS ALL LICENSE APPLICANTS PLEASE NOTE: A license to carry a loaded handgun may be issued for PROTECTION or ALL PROPER PURPOSES. One or more of these reasons must be noted on the application, in the space provided for reason(s) for which you make application to carry a pistol in New Hampshire. RENEWAL APPLICANTS PLEASE NOTE: In order to expedite license issuance procedures for those applicants who currently hold a valid NH concealed carry license, and are submitting a renewal application WITHIN 30 DAYS OF EXPIRATION, it will be necessary for the applicant to record on the application form the license number and date of expiration of their handgun license. Mail to: NH State Police Permits and License Unit 33 Hazen Drive Concord, NH 03305 FEE FOR ALL NON-RESIDENT APPLICATIONS: $100.00 (Five Year Permit) Make checks payable to: STATE OF N.H. - TREASURER Applications, NH Law and Administrative Rules governing non-resident Pistol/Revolver Licenses can be found on the State Police website at http://www.nh.gov/safety/divisions/nhsp/ssb/permitslicensing/plupr.html
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