S.P. 634 (Rev. 07/18)
STATE OF NEW JERSEY
Certificate of Eligibility
(This form must be completed for each transfer of a Shotgun or Rifle, including black powder or BB Rifle)
White copy is to be retained by the transferor pursuant to N.J.S.A. 2C:58-3b.
Yellow copy is to be retained by the receiver. If electronic form, make and sign two copies.
PART 1: This section must be completed by the TRANSFEROR (seller or giver) of the firearm.
Make of Firearm Action (pump, lever, semi-automatic, bolt, etc.) Model Caliber or Gauge
Serial Number
Private Dealer
Transferor (or Dealer Employee) Last Name First Name
MI
Type of Transfer
Dealer Name (if applicable) Dealer State Firearms License Number Transferor's Firearms ID Card Number
Exemptions
Address of Transferor (Dealer: List your licensed location.) Number & Street Town/City State ZIP Code
Between Law Enforcement Officers
Immediate Family
Licensed Curio/Relic Dealer
Approved Denied
NIC Number
Date of Transfer
PART 2: This section must be completed by the PERSON RECEIVING the firearm.
Receiver Last Name First Name MI Telephone
Address of Receiver Number & Street Town/City State ZIP Code
Date of Birth Receiver's Firearms Purchaser ID Card Number
1) Have you ever been convicted of a crime that has not been expunged or sealed?........................................................
2) Are you subject to any court order prohibiting you from possessing firearms?...............................................................
3) Are you subject to any court order issued pursuant to Domestic Violence?......................................................................
NOTICE: If you have had a Final Restraining Order issued against you within the last two years, you must
answer "Yes" and are ineligible to possess a firearm. The period of ineligibility is two years from the date of
issuance of the Final Restraining Order or the date it was dismissed whichever is longer.
4) Have you ever been convicted of a disorderly persons offense or its equivalent, in any jurisdiction, involving
an act of domestic violence that involved the offense(s) of (1) Simple Assault (2) False Imprisonment
(3) Lewdness (4) Criminal Trespass or (5) Harassment that has not been expunged or sealed?...............................
5) Are you an alcoholic? NOTE: A recovered alcoholic may answer no to this question...............................................
6) Are you dependent upon the use of any narcotic or other controlled dangerous substance?..................................
7) Do you suffer from any physical defect or sickness which makes it unsafe for you to handle firearms?................
8) Since the issuance of your Firearms I.D. Card, have you been confined for a mental disorder?.................................
9) Are you presently, or have you ever been a member of any organization which advocates or approves the
commission of acts of violence, either to overthrow the government of the United States or of this State, or
to deny others of their rights under the Constitution of either the United States or the State of New Jersey?..
10) Are you a fugitive from justice?..........................................................................................................................................................
11) What is your State of residence?
Yes No
Yes No
Yes
No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
If other than NJ, this transfer must go through a Licensed Firearms Dealer.
Signature of Transferor
Should you have any questions in completing this form, contact the Firearms
Investigation Unit, New Jersey State Police, P.O. Box 7068, West Trenton, NJ
08628-0068 (609) 882-2000 Ext. 2060 or 2061.
Questions 1 - 10 must be answered "no" for the transfer of the firearm to proceed. A
person who answers "yes" to any question is not eligible to receive a firearm.
Signature of Receiver
I hereby certify that the answers given on this form are complete, true and correct in every
particular. I realize that if any of the foregoing answers made by me are false, I am subject
to punishment.
Falsification of this form is a crime of the third degree as provided in NJS
2C:39-10c
NICS Check
Unless an exemption exists under N.J.S.A. 2C:58-3(2), The transfer of firearms will be conducted at a New Jersey Licensed Firearms Dealer
who will conduct a National Instant Criminal Background Check.
