CLEAR FORM
STATE OF NEW JERSEY
VOLUNTARY FORM OF FIREARMS REGISTRATION
(To register a firearm, all questions must be answered)
This is a three-part form — Type or press firmly with ball point pen
If internet form — complete and make two additional copies
Should you have questions regarding this form, contact the New Jersey State Police, Firearms Investigation Unit,
P .O. Box 7068, West Trenton, NJ 08628-0068, (609) 882-2000, ext. 2060 or 2061
This form may only be utilized to voluntarily register firearms you own that may be lawfully possessed
in New Jersey that were previously acquired under any one of the following circumstances:
1. Inherited pursuant to N.J.S.A. 2C:58-3j;
2. Lawfully acquired in another state pursuant to state and federal laws; or
3. Lawfully acquired in New Jersey pursuant to N.J.S.A. 2C:58-3a and N.J.S.A. 2C:58-3b.
You may not utilize this form to acquire firearms
OWNER INFORMATION:
Name (Last, First, Middle) _______________________________________________ Social Security No. ______________________________
Resident Ad dress: Number & Street _______________________________________________________________________________________
City _____________________________________________________
State _____________________________
Zip _____________________
Date of Birth __________________ Age ______ Home Phone ________________________ Work Phone __________________________
(Area Code)
(Area Code)
Firearms Purchaser I.D. Card No.
_______________ Driver's License No. & State _____________________________________
(If Applicable)
FIREARMS INFORMATION
(One form per firearm to be registered):
Manufacturer ____________________________________________________ Model _______________________________________________
Serial Number ___________________________________________________ Caliber or Gauge ______________________________________
Type:
Revolver
Pistol
Rifle
Shotgun
Other Marks of Identification ______________________________________________________________________________________________
SOURCE FROM WHICH YOU OBTAINED FIREARM:
Name
____________________________________________________________________________________________
(Person or Firearm Dealer)
Ad dress: Number & Street _______________________________________________________________________________________________
City _____________________________________________________
State _____________________________
Zip _____________________
Date Acquired _________________________________
Were you a resident of NJ when you acquired this firearm?
Yes
No
Was firearm acquired in N.J.?
Yes
No
Was firearm acquired through a will?
Yes
No
Death of next kin?
Yes
No
__________________________________________________________________________________
Signature of owner of firearm being registered
Date
The disclosure of my Social Security Number is vol un tary. Without this num ber, the processing of my ap pli ca tion
may be delayed. This num ber is used for doc u ment tracking only and is considered confidential.
White - To be mailed to Superintendent of State Police - Data Reduction Unit, P .O. Box 7068, West Trenton, N.J. 08628-0068
Yellow Copy - To Chief of Police, Municipality where you reside
Pink Copy - Owner's Copy
If Internet Form - Send original to Superintendent of State Police, copy to the chief of police of the municipality where you reside and owner to retain a copy.
Additional forms may be obtained through the New Jersey State Police, Firearms Investigation Unit,
P .O. Box 7068, West Trenton, NJ 08628-0068, or via the internet at
S.P . 650 (Rev. 01/08)