Private Sale / Co-Registration Of Firearm

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C
E
OUNTY OF
RIE
C
L. J
HRISTOPHER
ACOBS
C
C
OUNTY
LERK
Wilmer Fowler
Pistol Permit Supervisor
PER NEW YORK STATE SAFE ACT LAW: Effective March 15, 2013, ALL Private Firearms
Sales/Transfers (Co-Ownership Included) in New York State Require a Background Check of the
Buyer/Transferee. For More Information please visit
or call 1-855-LAW-GUNS.
PRIVATE SALE / CO-REGISTRATION OF FIREARM
DATE:___________
BUYER / CO-REGISTRANT:
[CIRCLE ONE]
Name _____________________________________________________________
Address ___________________________________________________________
City, State, Zip Code _________________________________________________
County of ________________
Permit # _______________________________
SELLER / OWNER:
[CIRCLE ONE]
Name _____________________________________________________________
Address ___________________________________________________________
City, State, Zip Code _________________________________________________
County of ________________
Permit # _____________________________
GUN INFORMATION
(All Information Below Is Required On Purchase Receipt For Transaction To Be Processed)
Make
Model
Type
Caliber
Serial Number
Buyer / Co-Registrant Signature: _____________________________________
Seller / Owner Signature: ___________________________________________
E
C
P
P
D
• 92 F
S
• B
, N.Y. • 14202 • P
: (716) 858-6600 • F
: (716) 858-6550
RIE
OUNTY
ISTOL
ERMIT
EPARTMENT
RANKLIN
TREET
UFFALO
HONE
AX

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