Fill - Free fillable Jorge O. Elorza Steven M. Pare Hugh T. (City of Providence) PDF form

325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

Jorge O. Elorza Steven M. Pare Hugh T. Clements Jr.

Mayor Commisioner Chief of Police

Providence Police Department

325 Washington Street

Providence, Rhode Island 02903

“Building Pride in Providence”

INSTRUCTIONS FOR APPLICATION FOR LICENSE TO CARRY

A CONCEALED PISTOL OR REVOLVER

No applications will be considered unless the following have been completed:

* This official application form must be filled out completely by the applicant.

Please print or type the application or IT WILL BE RETURNED.

* The application must be signed by a Notary Public prior to being submitted.

* Enclose two (2) (1”X 1”) pictures of the applicant, taken without head gear or glasses. This photo must be a

clear picture of the head and face. Please PRINT applicant’s name on the back of each picture. NO

LAMINATED PHOTOS WILL BE ACCEPTED.

* Proof of qualification before a certified weapons instructor, ie., NRA Instructor or Police Range Instructor

must be supplied, along with a copy of the instructor’s NRZ/FBI firearms instructors certification.

* Two types of positive identification must be submitted, photocopied, signed and dated by a Notary Public,

attesting to true copies.

* All NON-RESIDENT APPLICANTS must include a copy of their home state permit.

* All new applicants must include a full set of fingerprints to be submitted on FBI FINGERPRINT

APPLICATION CARD (FD-258 (Rev. 12-29-82)) included with the application. Fingerprint card must be

signed by applicant. FINGERPRINT CARD IS NOT REQUIRED FOR A RENEWAL APPLICATION.

* If the permit is to be issued for employment, a typed letter of explanation must be submitted by your

employer on your employer’s letterhead and included with the application.

* A letter must be submitted by all applicants stating a good or proper reason why a permit should be issued

and why the applicant is a suitable person to be licensed. Included in this letter must be a detailed explanation

as to how the applicant plans to properly secure his or her firearm so that it does not fall into unauthorized

hands. All letters must be original and dated. The City of Providence will not accept a photocopy of any letter

or signature.

* A letter of recommendation by all three references must be submitted by all applicants stating a good or

proper reason why a permit should be issued and why the applicant is a suitable person to be licensed. Included

in this letter must be the length of time the reference has known the applicant and an explanation as to the

nature of the relationship. All letters must be original, signed and dated. The City of Providence will not accept

a photocopy of any letter or signature.

325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

* A $40.00 CHECK or MONEY ORDER payable to the City of Providence must be presented when receiving

your permit. DO NOT SEND A CHECK OR MONEY ORDER WITH YOUR APPLICATION.

ONCE APPLICATION IS COMPLETED, PLEASE CONTACT THE COMMANDING OFFICER OF THE

LICENSE ENFORCEMENT UNIT TO SCHEDULE AN APPOINTMENT TO REVIEW THE

APPLICATION.

* Applicant will be notified by mail of approval or denial of permit. Telephone inquiries will not be accepted.

If approved, the applicant must appear in person to pick up permit. The application, fingerprint card and

photographs become a part of the records of the City of Providence and will not be returned.

* All permits will expire four (4) years from the date of issuance. Also, the renewal of your permit is your

obligation. No notification of expiration of the permit will be sent to you. Allow at least 90 days for the

processing of your application due to the fact that the City of Providence is dependent on other agencies for

information necessary to complete the application.

325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

CITY OF PROVIDENCE

APPLICATION FOR LICENSE TO CARRY A CONCEALED WEAPON PURSUANT TO

R.I.G.L. 11-47-11

DATE______________________ PERMIT NUMBER:_________________________

NAME:____________________________________________________________________________

First Middle Last

ADDRESS:_________________________________________________________________________

Street Name and Number (Post Office Box NOT ACCEPTED)

___________________________________________________________________________________

City or Town State and Zip Code

TELEPHONE NUMBER:______________________________________________________________

Home Business Cell

SOCIAL SECURITY NUMBER:_______________________ OCCUPATION:___________________

EMPLOYER:________________________________________________________________________

____________________________________________________________________________________

Employer Address City/Town State and Zip Code

DETAIL JOB

DESCRIPTION:____________________________________________________________________________

______________________________________________________________________________

DATE OF BIRTH:____________________________ PLACE OF BIRTH:_______________________

HEIGHT__________ WEIGHT___________ EYE COLOR___________ HAIR COLOR___________

ARE YOU A CITIZEN OF THE UNITED STATES?_____________ HOW LONG?_______________

(If you are not a citizen of the United States, a copy of both sides of your alien registration card must be

included with this application.)

LIST OF ALL PRIOR ADDRESSES FOR THE PAST THREE YEARS INCLUDING

DATES___________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________

HAVE YOU EVER BEEN ARRESTED OR HAD A RESTRAINING ORDER OR NO CONTACT ORDER

EVER ISSUED AGAINST YOU?____________ IF SO,

GIVE DETAILS________________________________________________________________

____________________________________________________________________________________

325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

HAVE YOU EVER BEEN UNDER GUARDIANSHIP OR CONFINED OR TRATED FOR MENTAL

ILLNESS?________________

IF SO, GIVE DETAILS________________________________________________________________

____________________________________________________________________________________

HAVE YOU EVER PLEAD NOLO CONTENDERE TO ANY CHARGE OR VIOLATION?________

IF SO, GIVE DETAILS________________________________________________________________

____________________________________________________________________________________

ARE YOU UNDER INDICTMENT IN ANY COURT FOR A CRIME PUNISHABLE BY IMPRISONMENT

EXCEEDING ONE YEAR?_______________________

IF SO, GIVE DETAILS AND DATES____________________________________________________

____________________________________________________________________________________

HAVE YOU EVER APPLIED FOR A PERMIT TO CARRY A CONCEALED PISTOL OR REVOLVER

FROM THE ATTORNEY GENERAL OR LOCAL CITY OR TOWN IN RHODE ISLAND?_____________

IF SO, IDENTIFY AGENCY WHERE APPLICATION WAS FILED:___________________________

IF SO, IS PERMIT CURRENTLY: _____________ _____________ _____________ ____________

ACTIVE EXPIRED DENIED REVOKED

(If you hold an expired permit, enclose a photocopy, notary signed and dated, attesting that the copies are

true)

HAVE YOU EVER APPLIED FOR A PISTOL PERMIT TO CARRY A HANDGUN IN ANOTHER

STATE?___________

IF SO, LIST CITY AND STATE_______________________________________________________

WERE YOU DENIED?_______________________________________________________________

IF SO, GIVE DETAILS_______________________________________________________________

SEND A PHOTOCOPY OF OUT OF STATE PERMIT

HAVE YOU EVER HAD A LEGAL NAME CHANGE?_____________________________________

IF YES, LIST ALL FORMER NAMES___________________________________________________

LIST ANY NICKNAMES OR

ALIASES___________________________________________________________________________

APPLICANT: ON A SEPARATE SHEET OF PAPER OR OFFICIAL LETTERHEAD, TYPE DETAILS

AND SPECIFIC REASONS WHY YOU FEEL YOU SHOULD BE ISSUED A CONCEALED WEAPON

PERMIT BY THE CITY OF PROVIDENCE AND WHY YOU ARE A SUTIABLE PERSON TO BE SO

LICENSED (ONLY TYPED LETTERS WILL BE ACCEPTED).

TWO (2) TYPES OF POSITIVE IDENTIFICATION MUST BE SUBMITTED.

EXAMPLES: Birth Certificate, Rhode Island or other State Drivers License, Rhode Island Identification Card,

Passport, etc.

325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

A PHOTOCOPY OF ANY TWO OF THE ABOVE MUST BE SIGNED AND DATED BY A NOTARY

PUBLIC, ATTESTING AS BEING TRUE COPIES WILL BE ACCEPTED.

LIST THREE (3) REFERENCES:

____________________________________________________________________________________

Name Address/City/State/Zip Telephone Years Known

____________________________________________________________________________________

Name Address/City/State/Zip Telephone Years Known

____________________________________________________________________________________

Name Address/City/State/Zip Telephone Years Known

NOTE: THE RHODE ISLAND COMBAT COURSE IS FOR LAW ENFORCEMENT PERSONNEL

ONLY. ALL OTHER MUST QUALIFY IN ACCORDANCE WITH R.I.G.L. 44-47-15.

WEAPON QUALIFICATION SCORE: CALIBER OF WEAPON:_________________________

_________________________________________________________________________________

ARMY-L SCORE RHODE ISLAND COMBAT SCORE

_________________________________________________________________________________

SIGNATURE OF N.R.A. INSTRUCTOR OR POLICE RANGE OFFICER

__________________________________________________________________________________

N.R.A NUMBER OR POLICE DEPARTMENT NAME

***********************************************************************************

I CERTIFY THAT I HAVE READ AND AM FAMILIAR WITH THE PROVISIONS OF 11-47-1 TO

11-47-62, INCLUSIVE, OF THE GENERAL LAWS OF THE STATE OF RHODE ISLAND, 1956, AS

AMENDED, AS WELL AS ALL FEDERAL STATUTES PERTAINING TO FIREARMS AND THAT I AM

AWARE OF THE PENALTIES FOR VIOLATIONS OF THE PROVISIONS OF THE CITED SECTIONS. I

FURTHER UNDERSTAND THAT ANY ALTERATION OF THIS PERMIT IS JUST CAUSE FOR

REVOCATION. THE CALIBER OF THE FIREARM THAT IS CARRIED MAY NOT EXCEED THE

CALIBER LISTED ON THE PERMIT.

__________________________________________

Applicant’s Signature

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325 Washington Street * Providence, Rhode Island 02903 * (401) 272-3121 * Fax: (401) 243-6464 * TDD #: (401) 831-3456

BEFORE A NOTARY PUBLIC

SUBSCRIBED AND SWORN BEFORE ME IN ______________________________, RHODE ISLAND,

THIS ______________________ DAY OF _____________________, 20____.

____________________________________________________________________________________

Notary Public Signature Notary Public (Name Printed)

MY COMMISSION EXPIRES ON ______________________________________________________

Month Year State

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