Norwalk Police Department Temporarv State Pistol Permit ...

Norwalk Police Department

Temporarv State Pistol Permit Application andInstructions for Norwalk Residents

Records DivisionOne Monroe StreetNorwalk, CT 06854

(203) 8s4-300e

Dear Applicant:

You MUST be a bona fide permanent resident of the Citvof Norwalk to be eligible to apply. Non-resident property/business

owners are not eligible. You must be 2l years old at the time yousubmit your application.

The State of Connecticut has implemented a MandatoryOnline Pre-Enrollment procedure for fingerprint criminal historychecks through the Connecticut Criminal History Request System(CCHRS) in which you must submit your information and pay the

State and Federal fees online and then receive an Appli cantTransaction Number (ATN). Please follow the following Steps tobe fingerprinted and submit an application for a temporary PistolPermit.

STEP # 1 - Online Pre-Enrollment with theState of Connecticut:

L. Go to https://ct.flexcheck.us.idemia.io/cchrspreenroll (thislink will also be on the Norwalk Police website)

2. Enter the Service Code E91E-8915 (designated only forNorwalk residents applying for a Pistol permit)

3. Enter your required information and pay the State $75and FBI $13.25 fees (no longer collected by the police)

4. Print out Applicant Transaction Number (ATN) - youmust have this number at fingerprinting. You cannot be

fingerprinted without this Applicant TransactionNumber.

STEP # 2 - Schedule FineerprintAppointment Online.

ALL FINGERPRINTING IS NOW BY ONLINEAPPOTNTMENT ONLY ! - NO WALK-INS WILL BEACCEPTED.

1. To make a fingerprint appointment you can:

A: Go to the Norwalk Police website under theFAQs -'oHow do I Obtain a Pistol Permit" link andclick on ooFingerprinting Online Scheduling" andchoose a date and time slot. OR

B: type o6Norwalk Online Appointment Hub" intoyour internet browser and choose the calendar for66All Fingerprinting Services" OR

C : Got to www.norwalkct.org/fingerprinting

Fingerprinting Hours :

TUESDAY: 9:00 am - 12:00 pm & 1:30 pm - 4:00 pm

WEDNESDAY: 9:00 am - 12:00 pm & 1:30 pm - 4:00 pm.

STEP # 3 - Items vou MIIST have at vourfingerprint appointment.

**Below is a check-off list of the items that you MUST bring withyou for your fingerprint appointment. Failure to have any of the

items listed will make your application incomplete and you willNOT be fingerprinted. Make sure you have each Item Number.

1. FULLY COMPLETED APPLTCATION:On a State of Connecticut Pistol Permit Application

Form DPS-799-C (revised 3/03/21). Outdated forms willnot be accepted. Check off the box for "60 Day TemporaryState Pistol Permit" on page 1. All Questions must be

answered.

2. NOTARIZED APPLICATION: Have the applicationnotarized prior to your arrival. We do not notarize applications.

3. APPLTCANT TRANSACTION NUMBER (ATN)Must bring a print out of the Applicant Transaction Number

(ATN) that you were issued at the completion of the online pre-

Enrollment. You CANNOT be fingerprinted without this number.

A. BASTC PISTOL SAFETY COURSE CERTIFICATE:An original Certificate of Completion for a course approved by the

Commissioner of Public Safety in the safety and use of pistols and

revolvers.**If you are submitting a NRA certificate that has been issued

after May of 2016, they must be the new NRA approved form withLevel I - 4 completion. '(**The NRA's ooHome Firearms Safety

Courseo' and o'First Steps Pistol Orientation Program" areNOT accepted.

5. PHOTO: One (1) passport size color photo of yourself toattach to application.

6. PAYMENT:

Norwalk Police Fee : $70 (fingerprinting and background)

Pavment Methods: CASH or DEBIT/CREDIT CARD orMONEY ORDER- payable to o'@".

7. VALID PHOTO IDENTIFICATION: Proof of youridentity and Norwalk Residency.

- State of Connecticut Driver License;OR

- State of CT Photo Identilication Card

Must show a Norwalk address 'r**Change License andRegistration with CT DMV prior to fingerprint appointment ifnecessary.

- Out of State Licenses NOT accepted.

8. PROOF of U.S. CITIZENSHIP or Lesallv in the U.S.

You Must Bring One of the Following:Your United States Birth Certificate;

ORYour Valid United States PassPort;

ORYour Valid United States Permanent Resident Card

B) Non-Immierant Alien in the United States legallv:1 - Visa or l-94 form (vatid)2 - Exceptions under 18 USC 922(y\(2)

- Admitted to U.S. for hunting or has a validhunting license.

- Or received a waiver for the LJ.S. AttorneyGeneral.

9. The Temporary Pistol Permit is valid for only 60 days fromthe date it is signed. You must then convert the TemporaryPistol Permit to a State Permit with the Connecticut StatePolice and book an appointment on their website.

10. WARNING: You must list all applicable arrests andconvictions from any State or Jurisdiction in the CriminalHistory Section on page 3 of the application.

Failing to provide accurate and complete information mayresult in the violation of Connecticut General Statute 53a-157b

- False Statement. This may lead to an arrest warrant for theomission of disqualifying arrests and convictions.

11. A conviction may consist of a variety of dispositions suchas: being found guilty at trial or pleading guilty to lessercharges. You may serve jail time or receive suspended jailtime. You may have received suspended jail time and paid afine. Received Probation or a Conditional Discharge. Just

because you didn't go to jail does not mean you were notconvicted of a crime. If not sure, list them, it is yourresponsibility.

12. The CT Judicial website only contains convictioninformation that goes back L0 years from the current date. Ifyou are not sure of your conviction status, you can go towww.ct.sov/dps and download the 66CRIMINAL HISTORYRECORD REQUEST FORM" and follow the instructions toget your criminal record prior to filling out the pistol permitapplication.

Any Questions contact:

(best option due to availability)

Revised 712612021 Lt. Weisgerber

Lt. Art Weisgerber203-854-3164

NORWALK POLICE DEPT.

Connecticut Criminal History Request System

Fingerprint Service Code Form

Service Name: TEMPORARY PISTOL PERMIT

To register for your fingerprints to be taken, please visit

https://ct.flexcheck.us.idemia.iolcchrsoreenroll and enter the followingService Code:

E91E-8915

Service Code is unique to your hiring/licensing agency. Do not use this code for onother purpose.

After entering the Service Code, confirm the Fingerprint Reason by selecting the "Yes - This information

looks Correct" option.Complete the Pre-Enrollment information as completely as possible. All fields in bold font/blue highlight

are mandatory to move forward with the process. After filling out all applicable fields, move to the next

section by selecting the "submit Pre-Enrollment" button at the bottom of the screen.

After completing the pre-enrollment steps, a confirmation screen will appear confirming registration is

complete, including your Applicant Tracking Number. This Trackins Number will need to be taken tovour fingerprinting session. lt will also be sent to the e-mail address vou providg{.4llrins registration.

Coeatcg C.fiad kilt irq*tl gtlas

PreEnrollment

Itr,..,ji:t! ... . i.r l.i,i,1iir, j..r:,r:i E irr !::'3r

r& *, 'fi![! .n .F$ arod lE ({Htt tris rht F5.& ro! -l.t !o!r ^}Ftr

r.r ri}lit t{-Btsrc* r& *n ld 6& d..'sr6 d rn. ltN rinqarlq. I. !r..^

{f *e :tf &lj'Bat*t @F ddk etat6. ad iil i.r&. * . dd4 * rrlry

Apgn<rd 118!69 t{nrk liToml0:5

aarf, rtDot mwarcl l:) lJr lt$

strs/2c21

-p..!.Dr**nrrhrAlp,(rrrl..nnBNrmbdkr.*..th.ira.r!riniioLrio! lril.cP.,nlYborhrr'.rtr'nrpJrint!!pr1r'.q!r]..irr.ri.nr!nr.n!Iy.?r.N,nfrh.rr!!x\ Y.LF.n.bv'drlhtrnJtrbr,,nordp,lob.i^N.,r,ni4 Fts,1.\ilbi\, jlr?flil",pn! rlFdi(,h!i'J+1.iri!,on

Appli.antTndlnttlumber; I

ffi ltil lilt ilt lil il1il I il illt llililt lil

1 -THE FORM ON THE LEFT IS WHAT YOU WLL SEE ONCE YOU SUCCESSFULLY

COMPLETE TH E PRE-EN ROLLEMT.

2 -THE FORM ON THE RIGHT IS THE PRINTED APPLICANT TRANSACTION

NUMBER (ATN) THAT YOU MUST PRESENT AT YOUR FINGERPRINT

APPOINTMENT.

3 - YOU CANNOT BE FINGERPRINTED WITHOUT A TRANSACTION NUMBER!

!l \lr. ,!t { (!\\t( il{'l I

l),l..,.rr:.\l,,i |\llli..!\ ; r:i;iri i\ r\r,jI ii.r! lir,itI rr"\I'i\1.jri...rl.i .!l ri: r.

lrr.,.',' I l,r n1":r.,rr d

STATE OF CONI{ECTICUTDEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICESpecial Licensing and Firearms Unit

PISTOL PE RMIT/ELIGIBI LITY CE RTI FICATE AP PLICATION

For Department of Emergency Services and Public Protection (DESPP), Division of State Police, pistol permit locations, accesswww.ct.qov/despp and follow the link to the Special Licensing and Firearms Unit or call (860) 685-8290. Note: All payments mustbe made with separate checks.

fo C.G.S. .S$ 29-28 et s 29-36 et. and 53a-217 et.

Before compteting this apptication, it rs suggesfed that you review the Connecticut General Sfafufes peftaining to

firearms. These can be accessed on the lnternet at www.cqa.ct.qov or through your local library.Type of Permit Reque$qd:

Check Box:

I OO Oay Temporary State Pistol Permit

! Non-Resident State Pistol Permit

X Eliginitity Certificate to Purchase Pistols or RevolversE ftigiuitity Certificate to Purchase Long Guns_

lnstructions:

lnstructions for State Pistol Permits:lnstructions for Non-Resident

State Pistol Permits:

lnstructions for EligibilityCertificates to Purchase Pistolsor Revolvers and/or EligibilityCertificates to Purchase LongGuns:

1. Complete this form (DPS-799-C) and submit toappropriate local authority (local police, residentstate trooper or first select person, as applicable)along with all of the following:

. Firearms Safety & Use Course Certificate;

. $70.00, fee, payable to the local authority;and. Proof you are legally and lawfully in theUnited States (e.9., certified copy of birthcertificate, U.S. passport or documentationissued by l.C,E.).

2. Submit fingerprints for a criminal history checkthrough a law enforcement agency IIt Ct Ct

C, ntle4e- on lLrre fre- t*l*iln'ortt,u.-lk $k+< "( CT Pru*^

3. Upon approval, the local authority will issue aTerpporary State Permit to Carry Pistols andRevolvers (DPS-11-C), effective for 60 days.

4. Within the 60 day period, go to a DESPP,Division of State Police, pistol permit location andsubmit the following:

. The Temporary State Permit to Carry Pistolsand Revolvers (DPS-11-C) issued by thelocalauthority;

' A completed Application for State Permit toCarry Pistols and Revolvers (DPS-46-C);

. $70.00 fee, payable to Treasurer, State ofConnecticut;

_. Proof you are legally and laMully in theUnited States (e.9., certified copy of birthcertificate, U.S. passport or documentationissued by l.C.E.);and. Proof of valid state issued photo identificationcard.

5. Upon approval, your photograph will be taken atDESPP and you willbe issued a stafe pistolpermit.

**CALL DESPP FOR PACKET**You must hold a valid permit orlicense to carry a pistol or revolverissued by a recognized United Sfatesjurisdiction.

Complete this form and submit toDESPP, Division of State Police, pistolpermit location along with all of thefollowing:

Completed State of CT and Federalfingerprint card with $75.00 fee and$13.25 fee, payable to Treasurer,State of Connecticut for criminalhistory background checks;Firearms Safety & Use CourseCertificate;$70.00 fee, payable to Treasurer,State of Connecticut;Completed Application for StatePermit to Carry Pistols and Revolversform (DPS-46-C);Completed DPS-129-C signed andnotarized and 2x2 color photograph(passport style);Copy of the permit or license to carrya pistol or revolver issued to you by arecognized United States jurisdiction;Proof you are legally and lawfully inthe United States (e.9., certified copyof birth certiflcate, U.S. passport ordocumentation issued by LC.E.);andProof of valid state issued photoidentification card.

Out of State Pistol Permit lnformation:

State of lssue:

Expiration Date:

Permit Number:

Complete this form and submit inperson at DESPP Headquarters,Division of State Police, located at1111 Country Club Road,Middletown, Connecticut along withthe below;

. Firearms Safety & Use CourseCertificate;. $35.00 fee, payable toTreasurer, State ofConnecticut;

. Application for a State EligibilityCertificate for a Pistol orRevolver or for Long Guns(DPS-164-C);

. Proof you are legally andlawfully in the United States(e.g., certified copy of birthcertificate, U.S. passport ordocumentation issued byl.C.E.);and. Proof of valid state issued photo

identification card.

Submit fingerprints for a criminalhistory check through a lawenforcement agency. Fees include a$75.00 fee and a $13.25 fee, payableat the agency where the prints aretaken. Fees must be paid by separatechecks.

Upon approval, your photograph willbe taken at DESPP and you will beissued an eligibility certificate.

DPS-799-C (Rev. 03/03/2 I ) A n Affirm ativ e A c ti o n/E q u a I E mp I oy m e nt Op p o rt u n ity E mp lo y e r Page 1 of4

STATE OT CONIT{ECTICI TDEPARTMENT OF EMERGE}ICY SERITCES AND PIIBLIC PROTECTION

DI\iIISION Of STATE POLICE

Contact / ldentifying lnformation:

il

Name of Applicant

Tt]TNTtrITTLast

,EISuffix

In il[nn

Firstn

Middle lnitialil

Eovide all ottrer namis by which you have been known (Maiden name, Aliases, Nicknames, etc.)(Attach additional sheet(s), if necessary)

Date of Birth

nn/nn/nflnMonth/DaylYear

Sex

[r lrrlr fxHeight

Irt. [Irn.Weight

lllr-u'Eye ColorfI Brown tr giue n Btacrn Green n Gray I Hazel

Race

[whit" fAmerican lndianlAlaskan Native [AsianlPacific lslander

l-lgtacr l-lunkno*n ECItrer

Hair Golor[ tsrown n Black n Blonde n neaEeray nWhite neato

InrnntrrCity/Town

Socia! Security Number (optional, hutwill helpp rcve nt mi si dentilicati o n)ru[iltr-IuItr

Country of Citizenship

TtrItrDtrNtrNETtrTNTTTtr[tr[]Alien Reg. Number (lf applicable)

r--lrftT tEntrt]I[nnesiCential Address {List sfeet address. Post office box numheqqlq !q$!geE!e!lg|-NNtrTf TIITITtrTNNNTNN[t]NNTtrTNTTTTtrilNumber/Sfeet

TN, InState Zip Code

nnnCitv/Town

It lt I II llt!t-l

2

Lirst Residential Addresses for the Last 7 Years (Attach additional sheet(s), if necessary).Any subsequent changes of address must be reported within 48 hours to the Special Licensing and Firearms Unit1.

different from current residential address

nrfn, trnState

trTNII.ilTTNZip Code

llilllil il

Home Telephone llumber(trTN) trTN-TtrXNArea CodeAfternate Telephone l,lumber([xn)nItr-rIxnArea Code

Motor Vehicle Operator's Llcense Numherlrn[tr[rrnnrrrnnnf rlState of lssue

Emplovment History:List Employers for the Last 7 Years (Provide employer's name, address and telephone number)(Attach additional sheet(s), if necessary)1.

2.Permit or Eligibility Certificate History:

Have you had a firearms permit, permit application or eligibility certificate of any kind from ANY iurisdiction in theUnited States denied, suspended or revoked? nNO IIYES

lf "YES,' provide:

1. ldentifu the iurisdiction which issued the denial, suspension or rcvocation:

2. Date of denial, suspension or revocation:

3. The reason for the denial, suspension or revocation:

Dp9799-C (Rev. 03/03/21 ,4n -tfflnnatite acdon{Equal EmplE-rrreilt Apportai$, EtnploT,er Page 2 of4

nnState

Number/Street

STATE OF CONNECTICUTI}trPARTMENT OF EMERGENCY SERVICES ANI' PUBLIC PROTECTION

DTVISION OF STATE POLICEMedical Hiqtory:

Have you been confined in a hospitalfor mental illness in the past sixty (60) months by order of a Probate Gourt?

nNO ilVfS lf 'YES," explain: (Attach additional sheet(s), if necessary)

Have you been discharged from custody within the past twenty years after having been found not guilty of a crimeby reason of a mental disease or defect? trttO nyESlf "YES," explain: (Attach additional sheet(s), if necessary)

Have you been voluntarily admitted to a hospilal for mental illness within the past six (6) months for reasons otherthan solely for alcohol or drug dependencee INo ilYESlf "YES,. explain: (Attach additional sheet(s), if necessary)

Notice: DESPP herein notifies the applicant that, pursuant fo C.G.S. $$ 29-28 through 29-38b, DESPP will be notified by the

Department of Mental Health and Addiction Serylces if the applicanf has been confined to a hospital for psychiatric

disabitities within the preceding sixty (60) months by order of Probate Court, or if the applicant has been voluntarily admittedto a hospitalfor menial itlness within fhe pasf slx (6) rnonths for reasons other tha

Criminal History:Enyjurisdiction?trt.tonYESlf"YES,"listallarrests,indicating

charges, locations, dates of arrest and dispositions. (Attach additional sheet(s), if necessary)

ItJotrce; You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have

been erased pursuantto C.G.S. $S46b-146, 54-76o, or 54-142a.|f your criminal records have been erased pursuant to one of

these statutes, you may swear under oath trat you have never been arrested. Criminal records that may be erased are recordspertaining to a finding of delinquency or that a child was a member of a family with service needs (C.G.S. 46b-146), an

adjudication as a youthful offender (C.G.S. 54-76o), a criminal charge that has been dismissed or nolled, a criminal charge forwhich the person has been found not guilty, or a conviction for which the person received an absolute pardon (C.G.S. 54-

142a).

With regard to criminal history information arising from jurisdictions other than the State of Connecticut: You are not required

to diselose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to the

law of the other iurisdiction. Additionally, you are not required to disclose the existence of an arrest arising from anotherjurisdiction if you are permitted under the law of that jurisdiction to swear under oaih that you have never been arrested.

Have you ever been CONMCTED under the laws of this state, federal law or the laws of another iurisdiction?f ffO [VeS lf 'YES,' list all convictions, include charges, location, date of arrest, and disposition. (Atiach additionalsheet(s), if necessary)

Are you currently on probation, parole, work release, in an alcohol and/or drug treatment program or other pre-trialdiversionary program or currently released on personal recognizance, a written promise to appear or a bail bond fora pending court case? DNO f,yfS ff "YES," explain. (Attach additional sheet(s), if necessary)

Within the past five (5) years, have you been the subiect of a Protective Order or Restraining Order issued by a courtin a case involving the use, attempted use or threatened use of physical force against another person, regardless ofthe outcome or result of any related criminal case? ENO IyeS

lf "YES,' which court issued the order?

Military History:

WereyoueveramemtleroftheArmedForcesoftheUnitedStates? nNO IYES(lfyes,pleaseincludeacopyofyourDD-214)

Were you ever discharged from the Armed Forses of the United States with a less than Honorable Discharge? nNO f]YES

DPS,799-C (Ret 03/03/21) AnAlfintalix Action/EqualEntploTmtent Apportwi$'Empl.oyer Page 3 of4

STATE OF CONl.lECTICtrfI}EPARTMENT OF EMERGENCY SERVICES AND PLTBLIC PROTECTIOI{

DTV]ISION OF STATE POLICE

Proof of Training:

"A#ach a cfrpy af the letter or wftificate affesfiing that you have complefed a course in the safety and use of pislols andreyolyers or iong guns (as appropiate, depending upon wh"tch permit or certificate you are requesting), signed by the inslructorof the course.lnstruc'tor: (Check applicable box)

[National Rifle Association[Departrnent of Energy and Environmental Protection (DEEFI

Iother:

State lnstructor's Name and lD Number:

Declaration:n-wnichldonotbelievetobetrueandwhichisintendedtomisleadapublic

servant in the performance of his or her official function, is punishable by law (See C.G"S. $ 53a-157b). I further understand

that any statement in this application that is determined to be false or inaccurate shall constitute grounds for ihe denial ofsuch application. lf approved before the facts are known, such approval shall be void if based on a false or inaccurate

statement. My signature below attests to the accuracy, completeness and to the truth of all information supplied on thisapplication:

I declare, under the penalties of false statement, that the answers to the above are true and correct.

Date Signed

STATE OF

Print NameCOUNTY OF

Subscribed and swom to before me this

-

day of 2A

Name:Notary PublicMy Commission Expires:Commissioner of Superior Court

NOTICE: Appeal Process for Permits

ln the event that your application for pistol permit or eligibility certificate is denied or revoked, you may notify theBoard of Firearms Permit Examiners, at 165 CapltolAve., Suite 1070, l-Nartford, CT 06106. Telephone: (860)256-2947, in writing, within ninety {90) days, in order to begin your appeal process. At a hearing before theBoard, you may request that your application be reconsidered or that your permit or eligibility certificate be

reinstated.

furOtrtcialUse Only:Application Received:

[tr/[tr/nntrtrMonth/DaylYear

FBlSent: lJt'io l--lvesFBI Reply: Iruo IYesICE Response: Eruo trv*tDMHAS: !t'to f,vessPBt: trr.ro f]vesNumber:

Application Status:

lnpproved [Denied

(Signature and title of issuing authority)

DP$799-C (Rev, 03/03121) An Afffumatfue Action/Equal Enryloynent Opportwi4' Entpl.oyer Page 4 of4

STATE OF CONNECTICUTDEPARTMENT OF EMERGENCY SERVICES AND PUBLTC PROTECTION

DIVISION OF STATE POLICE

lnstructions to Applicants

Renewals for Armed Securitv Officers (Blue Cards/Class {} and Bail Enforcement Aqents (Gold Cards/Class2)

1. Follow the instructions above for Pistol Permits - Renewal ln-Person.2. An additional check or money order for $62.00 is required, made payable to "Treasurer, State of Connecticut."

3. lnclude a self-addressed, stamped #10 envelope.4. Armed Security Officers must submit a DPS-1030-C annually as proof of completion of the handgun qualification refresher course.

Eliqibilitv Certificates (New & Renewals)

1. New applicants must complete the DPS-799-C and DPS-164-C, and sign it in the presence of an official when your photo is taken.

2. Submit an affidavit signed by an instructor certified by the State, the National Rifle Association, or the Department of Energy and Environmental Protection

statingthattheapplicantsuccessfullycompletedasafetyortrainingcourseintheuseof pistolsorrevolversorlongguns, Suchstatementshall specifythatthe instructor was so certified at the time that he taught the course, and shall include the full name of the applicant, and the date, location and duration of the

course.3. Submit fingerprints with two (2) separate checks or money orders to cover the federal processing

payableto"Treasurer,StateofConnecticut", fortherequiredcriminal backgroundchecks.4. Submit an additional check or money order for $35.00 made payable to "Treasurer, State of Connecticut" for the

are appearing in person, exact cash payments will be accepted.processing of the Eligibility Certificate. lf you

5. When applicable, criminal andior mental health records must be submitted per Connecticut General Statutes Section 29-369.

6. Renewal applicants must submit a DPS-129-C-2, with $35.00 fee made payable to "Treasurer, State of Connecticut'and documentation of legal and lavvful

presence in the United States (see # 2 under "Pistol Permits NeW' for acceptable documents), if previously not verified. Do not mail cash.7 . lnclude a self-addressed, stamped #10 envelope.

Ammunition Certificates (New & Renewals):

1 . New applicants must complete DESPP4l7-C, and sign it in the presence of an official when your photo is taken.

2. Submit check or money order for $35.00 made payable to "Treasurer, State of Connecticut' or exact cash payment, for the processing of theAmmunition Certificate.

When applicable, criminal and/or mental health records must be submitted per Connecticut General Statutes Section 29-369

Renewal applicants must submit a DPS-129-C-2 with $35.00 fee made payable to "Treasurer State of Connecticut." Do not mail cash.

SEE IMPORTANT NOT'CES - REYERSE S'DE

fee of $13.25 and the state fee of $75.00, both made

Pistol Permits -New

Pistol Permits -Renewal In-Person

Pistol Permits -Renewal by Mail

1. A valid Temporary State Permit to CarryPistols or Revolvers (DPS-11-C) must bepresented in person at the Department ofEmergency Services and Public Protection(DESPP) Headquarters located at 11 11

Country Club Road, Middletown,Connecticut 06457-2389.

2. Proof of legal and lawful presence in theUnited States is required. Acceptable formsof proof include a birth certificate, U.S.passport, or documentation of permanentresidence from the U.S. Citizenship andlmmigratlon Services.

3. Payment of a $70-00 fee is required,either by check or money order madepayable to "Treasurer, State of Connecticut"or by exact cash payment.

4. Your photograph and signature will betaken at DESPP.

1. All pistol permits may be renewed in personat DESPP Headquarters ninety (90) days priorto expiration or up to ninety (90) days afterexpiration. No permit can be renewed after theninety (90) day grace period following theexpiration date.

2. Confirm the accuracy of the information onDPS-129-C. lf corrections are required, draw a

single Iine through any incorrect information andwrite in the correct information. Present thecorrected form to DESPP.

3. Bring a $70.00 check or money order madepayable to "Treasurer, State of Connecticut" orexact cash payment.

4. Provide proof of being legally and lawfully in

United States: U.S. Passport, Birth Certificateor Permanent Resident lD issued by LC.E. orNatu ralization Certif icate ;

NOTE: lf Place of Birth states,.VERIFIED',

you do not need to bring item # 4.

5. Your photograph and signature will be takenat DESPP.

1. Out-of-state pistol permits may be renewed by mail.Effective 1OlO1l11, in-state renewals may also be completedby mail.

2. Confirm the accuracy of the information on DPS-129-C. lfcorrections are required, draw a single line through anyincorrect information and write in the correct information. Signthe corrected form in the presence of a notary prior tomailing.

3. Using transparent tape, attach a 2" x 2" color passportphoto, taken within the previous six (6) months, in the boxprovided.

4. lnclude a $70.00 check or money order made payable to"Treasurer, State of Connecticut." Do not send cash.

4. Proof of legal and lawful presence in the United States isrequired. Acceptable forms of proof include a birth certificate,U.S. passport, or documentation of permanent residencefrom the U.S. Citizenship and lmmigration Services. Do notsend originals.

5. lnclude a self-addressed, stamped #'10 envelope.

DPS-769-C (Ret. 1 2/28/2018) A n Affirmalive Actio n/E qual Employme nt Opportunily Employ er Page 1 ol 2

STATE OF COI\-NTCTICUTDEPARTI}TENT OF EMERGENCY SERVICES AN:D PLBLIC PROTECTION

DI\'ISION OF STATE POLICENOTICE

pursuant to C G s $S 29-28, 29-32,2S-36f 29-36l, and 1 B U S.C. S 922, app/ications covercd by these rrs0'r/Ctlons will not be tssued or tre rercved if

?. You h*re a FELONY CONVICTIAN in any jurisdiction.

2. You have a MISDEMEANORCONV|CTION in Connecticut for one of the following crimes; After 10/01/1994a. lllegal possession of controlled or hallucinogenic substances, as specifled under C G S. $ 21a-279

b Criminally negligent homiqde as specitied under C.G.S S 53a-58c. Assaull in the thrrd degree as speci{ied under C.G S $ 53a-61d. Assault of an etderly, blind. disabled or pregnant person or a person wrth intelledual disability in the third degree as spectfled under C.G.S $

53+61ae. Threateninqintheseconddegreeasspecified underC.G S S53a-62f. Reckless endangerment in the first degree as specified under C.G S $ 53a-63

S Unlawful restraint in the second degree as specilied under C.G.S S 53a-96

h Riot in the irst degree as specilied under C G S. $ 53a-1 75i. Riot in the secord degree as specified under C G S $ 53a-1 76j lnciting to riot as specifled under C G.S $ 53a-178k Stalking in the second degree as speci{ied under C G.S. $ 53a-181d

3. youareanunlaw{ul userof oraddictedtoarrycontrolledsubstance(asdefinedintheControlled SubstancesAct(21 U.S.C.801, et. seq.}.

4. You were CO NVI,CTED ot a MISDEMEA NOR CRIME of DOMESTIC V IOLENC E'

This means an offense that (1 ) is a misdemeanor under federal or stale laiv, and (2) has. as an element. the use or attempted use of physical force, or

lhe lhreatened use of a deadly rrcapon, committed by a currenl or {ormer spouse, parent or guardian of the victim, or by a person wtth whom the victim

shares a chitd in common, or by a person who is cohabitirs with or trho has cohabited with the viclim or spouse, parent, or guardian, or by any person

similarly siluated lo a spouse, parent orgusrdian ot the viCim.

You nere diacharged from custody within the preceding 20 lrearc afrer having heen ioutd lfrT GIfiL7Y AF A CNtiE EV REASOTV OF[fEiI?'{[ I}TSEIISE OR I]EFECT pursuantto C.G.S. $ 53a'13-

you rerc CO TfiITUEO TO A ,fiSFfiAL for persons with psycfriatric disahilities {C.G.S. S t?a-495) within the preoeding sify {60} months byorder of a FrobaE Cosrt.

you have been voluntarily admitted to a hospital ior persohB nith psychhtric disabilities, within the preoeding six (6) months for reasonsother than Bol€ly ftr alcohol or drug dependene.

you are subilrt b a fiESfnAIArrItlG OFIIER or FROIECrTIE OFOER iesued hf 4 cou* after noiiEc and an oppoilunity to be heard has beenprcvided to 1pu in a casc involving the uss, attemplsd use or threatened use of pttysical force against another pGIEon.

You are the sublxt oil a court iasued risk !ilarrant to $€ic firearnp pursuafi to g.G.S. S 2g-30c(d).

You arc an IILEGAf ALlEltl in lhe United $tatea.

You are {IVOER tIre.AGE of21 yeae.

12. You ha\re renosnqed your United $tates EitiEnship.

13. You have been discharged from the Armed ForceE under a dishonorable condition.

14. You are prohibiled bUr ftderal hw, under I I U.B.C. S22 (gl or (nl.

Please nra1 in your reflewal or direct any questions regarding your slatus to DESPP Headquarters, Special Licensing and Firearrls Uni[ Iocated at 1 1 '11 Country

Club Road, tritltOletor,nr, Cannecticut 06457-238S ar by telephone at {860) 685-8290. Hours of operation arq Monday through Friday 8:30 am - 4:'15 pm. Preasercte att tocatiwe mfl !e cJpsed on State ard Fsdcrd lrdidys. Troop hcation may he closed during inclement lEather. No appoinweltts n€cessary.

6.

7.

8.

s.

10.

11.

Troop E - Montville l-3S5 N (between exits 6 & 9) lvtontuille, CT 06382, telephone 860-84&6539 -Tuesday, Wednesday. Friday, and Saturday B am - 12 pm and 12 30- 3.45 pm, Thursday 11 am -2 pm and 2 30 - 6 45 pm

Troop G - Bridgeport, 149 Prosped Streel, Bridgeport, Connecticut, 06604, telephone (203)696-2532Tuesday,Wednesday,Friday,andSaturdayBam-12pmand1230-3.45pm,Thursday11am-2pmand2.30-6.45pm

Current schedules, hours and directions can be found at www.ct.oov,/despp - click on Special Licensing and Firearms Unit link

Ivhntal Health and Addiction Services itthe applicant has been conlined in a hospital for persons with psychiatric disabilities within the preceding sixty(60) months by order of Probate Court, or il the applicant has been voluntarily admitted to a hospital for persons with psychiatric disabilities within thepreceding six (6) months for reasohs other than solely for alcohol or drug dependence. DESPP will use this informdion in order to fulfill its statutory

under Connecticut General Statutes Sections 29-28, 29-36f.

DPS769-C (Rer 12t28i2018) An,{fr matfu e Aetia ruEqual E mpia^m e nt Opp o tt tmi4, E mploye r Page 2 ot 2