Voluntary Form Of Firearms Registration Form - State Of New Jersey

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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, make & sign three copies
Should you have questions regarding this form, contact the Firearms Investigations Unit, New Jersey State Police,
P .O. Box 7068, West Trenton, NJ 08628-0068, (609) 882-2000, ext. 2060 or 2061
OWNER INFORMATION:
Name (Last, First, Middle) __________________________________________________________________ Soc. Sec. No. ________________________________
Resident Ad dress: Number & Street _______________________________________________________________________________________________________
City _______________________________________________________________________________ State ________
Zip ____________________________
Date of Birth ________________ Age _____ Home Phone __________________________________ Work Phone _____________________________________
Area Code
Area Code
Firearms Purchasers I.D. Card No.
____________________________ Driver's License No. & State____________________________________________
(If Applicable)
FIREARMS INFORMATION
(One form per firearm registered):
Manufacturer __________________________________________________________ Model ________________________________________________________
Serial Number _________________________________________________________ Caliber or Gauge _______________________________________________
Type:
Pistol
Rifle
Revolver
Shotgun
Other Marks of Identification _____________________________________________________________________________________________________________
SOURCE FROM WHICH YOU OBTAINED FIREARM:
Name (Last, First, Middle) ________________________________________________________________________________________________________________
Resident 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 through a will?
Yes
No
Death of next kin?
Yes
No
(The disclosure of my social security number is vol un tary. Without this num ber, the pro-
Was firearm acquired in N.J.?
Yes
No
cessing of my ap pli ca tion may be delayed. This num ber is used for doc u ment tracking
only and is considered confidential.)
_________________________________________________________________________________
Signature of owner of firearm being registered
Date
White
-
To be mailed to Superintendent of State Police, Box 7068 - Data Reduction Unit, P .O. Box 7068, West Trenton, N.J. 08628-0068
Yellow Copy
-
To Chief of Police, Municipality where you reside
S.P . 650
I
(Rev. 02/05)
Pink Copy
-
Owner's Copy

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