Pistol License Application (Nypd Retirees) - New York City Police Department Page 13

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New York City Police Department
License Division
One Police Plaza
New York, NY 10038
(646) 610-5536
Name:__________________________________________________________________
Application #:____________________________________________________________
Have your firearm(s) ever been removed from you at any time or surrendered for any reason
during your career as a law enforcement officer?
No____________
Yes___________
If your answer is Yes, please explain the circumstances in detail and indicate when your
firearm(s) were returned to you: (This form is necessary for a complete file, but will not affect
the decision to issue a retired law-enforcement handgun license to a member retiring in good
standing with firearms.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________
Signature
False written statements in this document are punishable under Section 210.45 of the NY Penal
Law (making a punishable written statement) and also will be sufficient cause for denial of an
application, license or permit by the New York City Police Department, License Division)
Rev. July 2013

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