Fillable Instructions for Adding or Removing a Firearm on (monroe county)

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Instructions for Adding or Removing a Firearm on (monroe county)

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BROWSE MONROE COUNTY (NY) FORMS

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Page 1 of 6
Instructions for Adding or Removing a Firearm on Your
Pistol Permit by Mail
Please mail the following items to our office:
• Original filled out amendment form
• A copy of the Bill of Sale from a Federal Firearms Licensed (FFL)
Dealer
• A copy of your entire pistol permit (including firearm cards)
• Payment of $3 - cash or check made out to Monroe County Clerk
Mailing Address:
39 West Main Street
ATTN: Pistol Permit Unit
Rochester, NY 14614
Upon review and acceptance of these documents, a clerk will mail back an updated permit and a
coupon. PLEASE ALLOW AT LEAST 14 DAYS FOR THIS PROCESS TO OCCUR. Do
not contact us about the status until it has been at least 14 days as your call or email will not be
returned.
If you have a plastic permit you are required to dispose of your old permit upon
receipt of your new permit. This does not apply to paper permits, you must keep
your old permit with your new permit.
If you have any questions, please contact is at 753-1642 or mcpistols@monroecounty.gov.
Instructions on how to fill out an amendment form are on pages 2-4 of this packet.
Jamie Romeo
Monroe County Clerk
Page 2 of 6
Fill out the following fields on the attached amendment
1. NYSID number, ends in a letter (note: not everyone’s permit will have this number
especially if you have a paper permit)
2. Date you are filling the amendment out
3. Full name on Pistol Permit
4. Date of Birth
5. Driver’s License Number from your NYS Driver’s License or Non Driver ID
6. Address listed on your pistol permit
7. Mailing address if different then physical address, only fill this out of you have previously
given us a different mailing address
8. Pistol Permit Number, written in the following format: permit number-year, i.e. 111-98
9. Date your permit was issued
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2
INSTRUCTIONS
Page 3 of 6
You need to fill out the following fields to complete your attached amendment:
1. Check the “Acquired” box or “Disposed” box under “Transaction Type”
2. Fill in the name of the FLL that you acquired or sold your firearm from/to
3. Fill in the “Manufacturer” field (i.e. Colt, Ruger, S&W)
4. “Pistol/Revolver/Single Shot” field. For Semi-Automatic firearms write “pistol”
5. “Model” field, if your firearm does not have a model put none.
6. “Caliber” field, if your firearm has a conversion kit please list the barrels it currently has,
“varies” is not an acceptable response and will be rejected.
7. “Serial Number” field, please write the number clearly to avoid rejection of form
8. Move to the bottom of the page and read the statement starting with “Have you been
arrested…” check yes or no. If yes please give details on the back of the amendment form
or on an attached sheet of paper.
9. Sign on the line that says “Signature of Licensee”
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INSTRUCTIONS
Not all permits will have this
REQUIRED
REQUIRED
REQUIRED
This is the address currently listed on your pistol permit, even if it is incorrect
If your mailing address is dierent then your physical address please ll this line out
REQUIRED
REQUIRED
Format of number-year, i.e. 111-98
LEAVE BLANK
LEAVE BLANK
REQUIRED FOR GUN PURCHASE. List name of Gun Dealer
REQUIRED FOR GUN REMOVAL. List name of Gun Dealer
Read statement, check yes or no. Sign name on “Signature of Licensee”
REQUIRED, SIGN HERE
Check “acquired” box for purchasing a gun
LEAVE BLANK
REQUIRED
REQUIRED
REQUIRED
REQUIRED REQUIRED
Check “disposed” box for selling a gun
REQUIRED REQUIRED
REQUIRED REQUIRED
REQUIRED
This section is only used for the three reasons listed
to the left. A police report MUST be submitted
LEAVE BLANK
REREQUQUIREDIRED
REQUIRED
Page 4 of 6
INSTRUCTIONS
PPB-5 (REV. 02/17)
STATE OF NEW YORK
PISTOL / REVOLVER LICENSE AMENDMENT
NYSID #
Date:
Amendment form for (check one):
______________________________________ County License
OR
New York State Police Pistol License
Nam
e
D
ate of Birth NY Driver’s License No. (or NY Non-Driver ID No.)
Physical Address (street, city, state, zip)
Mailing Address (if different)
Pistol License Number
Date Issued
Duplicate License Number
Date Issued
Transfer License Number
Date Issued
Transferred From
Transferred To
TRANSACTION TYPE(S) (Check all that apply):
Acquired Address Change Deceased Disposed Duplicate Lost / Stolen Firearm Name Change
Revoked Surrendered Suspended Transfer Other
AMEND LICENSE FOR THE FOLLOWING
1. New Name
2. New Physical Address
3. New Mailing Address (If different)
4. Following Weapon(s) Acquired From: (Name, Address)
Manufacturer
Pistol / Revolver /
Single Shot
Model
Frame
Only
Caliber(s) Serial Number
5. Following Weapon(s) Disposed to: (Name, Address)
Manufacturer
Pistol / Revolver /
Single Shot
Model
Frame
Only
Caliber(s) Serial Number
6. Following Weapons(s) has been: Lost Stolen Destroyed
Law Enforcement Agency Reported To:
Manufacturer
Pistol / Revolver /
Single Shot
Model
Frame
Only
Caliber(s) Serial Number
Have you been arrested, indicted, or convicted of any criminal offense, been the subject of an order of protection, or been
a patient at any mental institution since the above license was issued?
Yes No If Yes, give details on reverse.
Licensing Officer
Signature of Licensee
Page 5 of 6
Monroe
✔
Use the boxes below if additional space is needed.
Acquired, Disposed,
Lost, Stolen or
Destroyed
Manufacturer
Pistol /
Revolver /
Single Shot
Model
Frame
Only
Caliber(s) Serial Number
Name:
Carry No.:
Page 6 of 6
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Instructions for Adding or Removing a Firearm on (monroe county)

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Completed 14 February 2021

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