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.
FILE #:
Name
Date of Application
Mailing Address:
Street
City/Town
Driver’s License No.
State
Zip
Social Security No.
Legal Address (If different from above):
Telephone No.
(optional)
(optional)
Date of Birth Place of Birth Original Renewal
Height
Hair
Sex
Weight
Eyes
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?
No
Yes
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.
SIGNATURE OF APPLICANT:
Date
OFFICIAL USE ONLY:
Approved Denied
DSSP260 (REV. 03/17)
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
