Fillable PISTOL / REVOLVER LICENSE AMENDMENT (County of Ulster)

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PISTOL / REVOLVER LICENSE AMENDMENT (County of Ulster)

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The PISTOL / REVOLVER LICENSE AMENDMENT (County of Ulster) form is 2 pages long and contains:

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  • 41 check-boxes
  • 129 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County of Ulster

BROWSE COUNTY OF ULSTER (NY) FORMS

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PPB-5 (REV. 02/17)
STATE OF NEW YORK
PISTOL / REVOLVER LICENSE AMENDMENT
NYSID #
Date:
Name
Date 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):
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
Amendment form for (check one):
Ulster County License
OR
New York State Police Pistol License
✔
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
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PISTOL REVOLVER LICENSE AMENDMENT (County of Ulster)

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Completed 22 January 2021

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