NEW JERSEY STATE POLICE
NATIONAL INSTANT CRIMINAL BACKGROUND CHECK SYSTEM (NICS)
NICS DENIAL REQUEST FORM
You have been denied the transfer of a rearm due to a record in the NICS. You may request the reason(s)
for your denial by completing this form and returning it to the NICS Operation Center at the address listed
below. e NCIS Operation Center will respond to your request, via certi ed mail with the reason(s) for
your denial and information on rectifying your denial. e NICS Operation Center will not accept tele-
phone inquiries from denied persons prior to receiving the NICS DENIAL REQUEST FORM.
New Jersey State Police NICS Operation Center
I&IT Section, State Bureau of Identi cation
P.O. Box 7068
West Trenton, N.J. 08628-0068
STN Number : ______________________________________________________
Purchase Name : ______________________________________________________
Mailing Address : ______________________________________________________
______________________________________________________
Phone Number : ______________________________________________________
Date of Denial : ______________________________________________________
Signature : ______________________________________________________
Dealers Name : ______________________________________________________
Phone Number : ______________________________________________________
e NICS Operation Center will respond to your request, via certi ed mail
IDENTIFICATION
INFORMATION
TECHNOLOGY
SECTION
S.P. 670 (06/17)
