Fillable PLEASE READ ALL INSTRUCTIONS CAREFULLY (County of Ulster)

Fill Online, Printable, Fillable, Blank PLEASE READ ALL INSTRUCTIONS CAREFULLY (County of Ulster) Form

Use Fill to complete blank online COUNTY OF ULSTER (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PLEASE READ ALL INSTRUCTIONS CAREFULLY (County of Ulster)

On average this form takes 36 minutes to complete

The PLEASE READ ALL INSTRUCTIONS CAREFULLY (County of Ulster) form is 20 pages long and contains:

  • 0 signatures
  • 70 check-boxes
  • 113 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County of Ulster

BROWSE COUNTY OF ULSTER (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
PLEASE READ ALL INSTRUCTIONS CAREFULLY
Applications will not be accepted unless all requirements are complete.
Fingerprints and character references must be dated within six months prior to submission.
You must be 21 years of age to apply.
NYS Application Form:
Use Black ink only.
Begin the application on the line that says “Last Name”.
Two (2) applications forms must be completed and notarized*.
Each character reference must enter their name, address, and signature on both
applications. (Do not submit copies.)
You must include all dispositions for any past arrests.
Photographs must be taken at the Sheriff’s Office. The fee is $10.00.
*Notaries: Please do not place your stamp above the applicant’s signature on the application.
Fingerprints:
Fingerprinting is done electronically at a NYS contracted facility. Please see enclosed
instructions to schedule an appointment.
Character References:
Each reference listed on the NYS Application must also complete a separate reference form
and have it notarized.
Safety Course:
A 4 hour home safety course given by an NRA certified instructor is mandatory. A list of
instructors is included in this packet. You are not required to pick one from this list.
Applications are accepted between the hours of 8:30 am – 2:45 pm, Monday through Friday. If
you have any questions regarding the application process, please call (845) 340-4237, or (845)
340- 3639. You can also email mdon@co.ulster.ny.us.
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
NOTICE TO ALL APPLICANTS
1. Be careful answering the question, “Have you ever been arrested, summoned, charged,
or indicted anywhere for any offense, including DWI (except traffic infractions)”.
If you have ever been arrested, you must answer “yes”. This includes charges that have
been dismissed or sealed.
Any omission of fact or false statement will be sufficient cause to deny this
application and constitutes a crime punishable by fine, imprisonment, or both.
2. All applicants are required to provide this office with a detailed explanation citing your
need for a pistol license. You must establish “Proper Cause” under Article 400 of the
Penal Law. “Proper Cause” has been defined by New York State case law as “a special
need for self-protection distinguishable from that of the general community or of
persons engaged in the same profession.”
3. Character references can be any citizen of the USA 18 years or older. This includes
members of law enforcement and family members. They are not required to be a
resident of Ulster County, or New York State.
PLEASE HAVE ALL YOUR FORMS
COMPLETELY FILLED OUT BEFORE
SUBMITTING YOUR APPLICATION
/,(S7/tli( 77OI5r Prut or tlpe in black ink only
STATE OF NEW
YORK
PISTOL /REVOLVER LICENSE APPLICATION
NYS D NUmbei
I
I I
I I I
ln accordance wilh the Fedeal Pivacy Act ot 1974,
Wu
are hercby nolifted that
your
S@ial Secuity
Nurnber is not maNated
by
law. lt is Gquired by
the
Pistol Pennit Bureau
as
patt
of the stadatd
fot rccording Fieanns. Failure to disclose
yout
Social Securiy Number will
prohibil your
transaction frcm being
e.oded.
The
State Police will release Socia/ for reasons
law ot with wiften
consent
M Oaleol &dh MM DO YYYY N
l|l||lt
r]
YES
f]
NO
PhyselAddress
(Srreet
number
slreet
name
apanmenl
number .(y srale z'p.odel
Marhg Add.ess
(r
diflerenl
lM
physre
addres)
Primary Phoi€ Numbs
l@t.6b€r,
st€et
Mm6, apartnfrl nmber oty slare zp cod.)
SMn&ry
Phone
Number
lhqrqbyapplyforaPistol/RevolverLicenseto:(Checkonlyone)!CarryConcealedfl*PossessonPremisesE*Possess/CanyDuringEmploymenl
Premise Address or Employer Name and Address musl be
provrded
below:
Employer Name
(llCary
Ounno Emproyme.t) Address or othe. Locar on
(sle6lnumber
stret nare, aparime.t numbor
city slate zipcode)
A license is ,equired for the Iollowing rcasons:
Give four character references who
by their signalure atlest to
your goocl
molal character
S
Have
you
ever been arrested, summoned, charged or indicted anywhere for
any offense,
including DWl
(except
traf{ic inlractions)? YES NO
lf Yes furnish
the
followin
rnformation
Are
yo!
a
fugitive from
justice?
YES NO
Are
you
an unlafful user of or addicted
lo
any
controllod substance as defined in section 2'l U.S.C. 802?
YES NO
Are
you
an alien illegally or unlawfully in the L,nited States?
YES NO
Are
you
an alien admitted to the United States who does not
qualify
for the exceptions under 18 U.S.C. 922
{yX2)?
YES NO
Have
you
been
discharged
from
the Armed
Forces
under dishonorable conditions?
YES NO
Have
you
ever renounced
your
United States citizenship?
YES NO
Have
you
ever suftered any mental illness?
YES NO
Have
you
gver
been involuntarily committed to a mental health tacility?
E
YES NO
Have
you
ever had
a
pistol
/ revolver
license
revoked?
YES
tr
NO
Are
you
under
any
Iirearms
suspension or ineligibility order issued
pursuant
to the
provisions
of section
530.14 ol the
ctiminal
Drocedure
law
or section eioht hundred fortv-two-a oI lhe familv court act?
YES NO
Have
you
had a
guadian
appointed
for
you pursuant
to any
provision
oI state law, based on a determination that
as a
result
of marked subnormal intelligence, mental illness, incapacity,
condition or disease
you
lack
the
mental
capacily to contract or
E
YES
tr
NO
mana ur own
affairs?
Are
you
aware
oI any
good
cause for lhe denial oI lhe
license?
Are
you
prohibitod
from
posssssing
firearms under fedoral law, including
having been convicted
in
any court of a
misdemeanor cdme ot domeslic violence or being under indictment tor a crime
punishable
by imp sonrhent for
a term
exceodinq one
year?
YES NO
lf the answer to any
of the
questions
above
is YES,
explain
here
I
trtr
E
yes
Ero
Valid Until Revoked
For applicants under twenty-one
years
of age only:
Have
you
been
honorably discharged from the United
Stales Army, Navy, Marine
Corps, Air Force or Coast Guard, or the
National
Guard ot
the State of New York?
YES
!
NO
Knowingly
providing
false information
will be sufficient cause to deny this application
and
constitutes
a crime
punishable
by
fine, imprasonment, or both. I am aware
that the following
conditions affect any
license which may be issued to
me:
1. No license
issued
as a
resull
of
lhis application is
valid in
the Cry of
New York.
2. Any
license issued
as
a result ofthis application
will
be valrd only
for
a
pislol
or
revolver specifically described
in
lhe
license
properly
issued by the licensing ofricer.
3.
lf I
permanently
change my address, notice of such change
and my new
address
musl be foMarded to the
Superintendent
of the State Police and in
Nassau
County
and Suffolk
County,
to the licensing offcer of lhal county.
wilhin 10 days ofsuch change.
4 Any
license issued
as a
result
of
this application
is
subjecl to
revocalion
at any time by the
licensing officer or any
judge
or
juslice
of a court ol record.
Julat:
Signed
and swom to betote me
This
day ol
,20
at
sqnaturtai ofi@r Adm
n steins
oath
TteolOnice.
APPLICATION
NOT VALID UNLESS SWORN
Fingerprints submitted
electronically
by
lnvestigation Report
-
All
information
provided
by this
applicant has been verified:
S
gnarure
ol .vesl'gatn9 Ofii@r
This application
is Approved
-
Disapproved
lStrike
out
one) The tollowing
restriction(s) is
(are)
applicable
to this license:
T te and
Srgnahr€
of Li@ns
ng
Off@r
lf Licensing Ofticer authorizes the
possession
of a
pistol,
revolver or single shot
firearm(s)
at the time of
issue of original license,
furnish the following information:
tr
tr
tr
tr
ouptlcat. ol
rhi!.ppllc.ilon mu6t be lil€d with the superlniendent ot st.lr Pollco wlthi.10
days ot isEuance as rcqunod by Penal Law sec(on 400,00 suBo-s
/,(S7/tli( 77OI5r Prut or tlpe in black ink only
STATE OF NEW
YORK
PISTOL /REVOLVER LICENSE APPLICATION
NYS D NUmbei
I
I I
I I I
ln accordance wilh the Fedeal Pivacy Act ot 1974,
Wu
are hercby nolifted that
your
S@ial Secuity
Nurnber is not maNated
by
law. lt is Gquired by
the
Pistol Pennit Bureau
as
patt
of the stadatd
fot rccording Fieanns. Failure to disclose
yout
Social Securiy Number will
prohibil your
transaction frcm being
e.oded.
The
State Police will release Socia/ for reasons
law ot with wiften
consent
M Oaleol &dh MM DO YYYY N
l|l||lt
r]
YES
f]
NO
PhyselAddress
(Srreet
number
slreet
name
apanmenl
number .(y srale z'p.odel
Marhg Add.ess
(r
diflerenl
lM
physre
addres)
Primary Phoi€ Numbs
l@t.6b€r,
st€et
Mm6, apartnfrl nmber oty slare zp cod.)
SMn&ry
Phone
Number
lhqrqbyapplyforaPistol/RevolverLicenseto:(Checkonlyone)!CarryConcealedfl*PossessonPremisesE*Possess/CanyDuringEmploymenl
Premise Address or Employer Name and Address musl be
provrded
below:
Employer Name
(llCary
Ounno Emproyme.t) Address or othe. Locar on
(sle6lnumber
stret nare, aparime.t numbor
city slate zipcode)
A license is ,equired for the Iollowing rcasons:
Give four character references who
by their signalure atlest to
your goocl
molal character
S
Have
you
ever been arrested, summoned, charged or indicted anywhere for
any offense,
including DWl
(except
traf{ic inlractions)? YES NO
lf Yes furnish
the
followin
rnformation
Are
yo!
a
fugitive from
justice?
YES NO
Are
you
an unlafful user of or addicted
lo
any
controllod substance as defined in section 2'l U.S.C. 802?
YES NO
Are
you
an alien illegally or unlawfully in the L,nited States?
YES NO
Are
you
an alien admitted to the United States who does not
qualify
for the exceptions under 18 U.S.C. 922
{yX2)?
YES NO
Have
you
been
discharged
from
the Armed
Forces
under dishonorable conditions?
YES NO
Have
you
ever renounced
your
United States citizenship?
YES NO
Have
you
ever suftered any mental illness?
YES NO
Have
you
gver
been involuntarily committed to a mental health tacility?
E
YES NO
Have
you
ever had
a
pistol
/ revolver
license
revoked?
YES
tr
NO
Are
you
under
any
Iirearms
suspension or ineligibility order issued
pursuant
to the
provisions
of section
530.14 ol the
ctiminal
Drocedure
law
or section eioht hundred fortv-two-a oI lhe familv court act?
YES NO
Have
you
had a
guadian
appointed
for
you pursuant
to any
provision
oI state law, based on a determination that
as a
result
of marked subnormal intelligence, mental illness, incapacity,
condition or disease
you
lack
the
mental
capacily to contract or
E
YES
tr
NO
mana ur own
affairs?
Are
you
aware
oI any
good
cause for lhe denial oI lhe
license?
Are
you
prohibitod
from
posssssing
firearms under fedoral law, including
having been convicted
in
any court of a
misdemeanor cdme ot domeslic violence or being under indictment tor a crime
punishable
by imp sonrhent for
a term
exceodinq one
year?
YES NO
lf the answer to any
of the
questions
above
is YES,
explain
here
I
trtr
E
yes
Ero
Valid Until Revoked
For applicants under twenty-one
years
of age only:
Have
you
been
honorably discharged from the United
Stales Army, Navy, Marine
Corps, Air Force or Coast Guard, or the
National
Guard ot
the State of New York?
YES
!
NO
Knowingly
providing
false information
will be sufficient cause to deny this application
and
constitutes
a crime
punishable
by
fine, imprasonment, or both. I am aware
that the following
conditions affect any
license which may be issued to
me:
1. No license
issued
as a
resull
of
lhis application is
valid in
the Cry of
New York.
2. Any
license issued
as
a result ofthis application
will
be valrd only
for
a
pislol
or
revolver specifically described
in
lhe
license
properly
issued by the licensing ofricer.
3.
lf I
permanently
change my address, notice of such change
and my new
address
musl be foMarded to the
Superintendent
of the State Police and in
Nassau
County
and Suffolk
County,
to the licensing offcer of lhal county.
wilhin 10 days ofsuch change.
4 Any
license issued
as a
result
of
this application
is
subjecl to
revocalion
at any time by the
licensing officer or any
judge
or
juslice
of a court ol record.
Julat:
Signed
and swom to betote me
This
day ol
,20
at
sqnaturtai ofi@r Adm
n steins
oath
TteolOnice.
APPLICATION
NOT VALID UNLESS SWORN
Fingerprints submitted
electronically
by
lnvestigation Report
-
All
information
provided
by this
applicant has been verified:
S
gnarure
ol .vesl'gatn9 Ofii@r
This application
is Approved
-
Disapproved
lStrike
out
one) The tollowing
restriction(s) is
(are)
applicable
to this license:
T te and
Srgnahr€
of Li@ns
ng
Off@r
lf Licensing Ofticer authorizes the
possession
of a
pistol,
revolver or single shot
firearm(s)
at the time of
issue of original license,
furnish the following information:
tr
tr
tr
tr
ouptlcat. ol
rhi!.ppllc.ilon mu6t be lil€d with the superlniendent ot st.lr Pollco wlthi.10
days ot isEuance as rcqunod by Penal Law sec(on 400,00 suBo-s
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
FINGERPRINTING INSTRUCTIONS
All pistol license application fingerprints are done electronically through
IdentoGo. They have offices in Poughkeepsie, Middletown, Newburgh,
Liberty, Prattsville, and West Coxsackie.
To schedule an appointment call IdentoGo toll free at: (877) 472-6915.
Appointment scheduling via the call center is available from 9:00AM –
9:00PM, Monday through Saturday. You can also schedule your
appointment online at: https://www.identogo.com. You will be asked for the
Agency ID number for the Ulster County Sheriff’s Office: NY0550000, as
well as our Service Code: 155Z98.
You must bring at least one appropriate form of photo ID with you when
you go to your appointment. When you schedule your appointment, you will
be told what forms of ID are considered acceptable.
The Fingerprinting fee is $101.75. You must pay by check or credit card at
the time of your appointment. Cash is not accepted.
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
CHARACTER REFERENCE
On the Pistol License Application of __________________________ your name appears as a character
reference. Please supply the following information and return the notarized form to the applicant.
1. How long have you known the applicant?
2. Is the applicant related to you?
3. To your knowledge, has the applicant ever engaged in any illegal activity?
4. To your knowledge, has the applicant ever been arrested?
5. To your knowledge, has the applicant ever been treated for mental illness?
6. What is the applicant’s reputation in the community?
7. Does the applicant associate with persons of questionable character?
8. Do you believe the applicant has a need for a pistol license? If yes, why?
9. Do you believe the applicant is a person of good moral character?
10. In your opinion, does the applicant legally reside in Ulster County?
REMARKS:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Name (printed): __________________________________________________________
Address: ________________________________________________________________
Cell Phone #: __________________________ Business phone #: __________________
Residence Phone #: _____________________
Signature: _______________________________________________________________
Sworn to me this ______ day of ___________________
___________________________________ Notary Public
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
CHARACTER REFERENCE
On the Pistol License Application of __________________________ your name appears as a character
reference. Please supply the following information and return the notarized form to the applicant.
1. How long have you known the applicant?
2. Is the applicant related to you?
3. To your knowledge, has the applicant ever engaged in any illegal activity?
4. To your knowledge, has the applicant ever been arrested?
5. To your knowledge, has the applicant ever been treated for mental illness?
6. What is the applicant’s reputation in the community?
7. Does the applicant associate with persons of questionable character?
8. Do you believe the applicant has a need for a pistol license? If yes, why?
9. Do you believe the applicant is a person of good moral character?
10. In your opinion, does the applicant legally reside in Ulster County?
REMARKS:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Name (printed): __________________________________________________________
Address: ________________________________________________________________
Cell Phone #: __________________________ Business phone #: __________________
Residence Phone #: _____________________
Signature: _______________________________________________________________
Sworn to me this ______ day of ___________________
___________________________________ Notary Public
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
CHARACTER REFERENCE
On the Pistol License Application of __________________________ your name appears as a character
reference. Please supply the following information and return the notarized form to the applicant.
1. How long have you known the applicant?
2. Is the applicant related to you?
3. To your knowledge, has the applicant ever engaged in any illegal activity?
4. To your knowledge, has the applicant ever been arrested?
5. To your knowledge, has the applicant ever been treated for mental illness?
6. What is the applicant’s reputation in the community?
7. Does the applicant associate with persons of questionable character?
8. Do you believe the applicant has a need for a pistol license? If yes, why?
9. Do you believe the applicant is a person of good moral character?
10. In your opinion, does the applicant legally reside in Ulster County?
REMARKS:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Name (printed): __________________________________________________________
Address: ________________________________________________________________
Cell Phone #: __________________________ Business phone #: __________________
Residence Phone #: _____________________
Signature: _______________________________________________________________
Sworn to me this ______ day of ___________________
___________________________________ Notary Public
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
CHARACTER REFERENCE
On the Pistol License Application of __________________________ your name appears as a character
reference. Please supply the following information and return the notarized form to the applicant.
1. How long have you known the applicant?
2. Is the applicant related to you?
3. To your knowledge, has the applicant ever engaged in any illegal activity?
4. To your knowledge, has the applicant ever been arrested?
5. To your knowledge, has the applicant ever been treated for mental illness?
6. What is the applicant’s reputation in the community?
7. Does the applicant associate with persons of questionable character?
8. Do you believe the applicant has a need for a pistol license? If yes, why?
9. Do you believe the applicant is a person of good moral character?
10. In your opinion, does the applicant legally reside in Ulster County?
REMARKS:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Name (printed): __________________________________________________________
Address: ________________________________________________________________
Cell Phone #: __________________________ Business phone #: __________________
Residence Phone #: _____________________
Signature: _______________________________________________________________
Sworn to me this ______ day of ___________________
___________________________________ Notary Public
FIREARMS SAFETY COURSE INSTRUCTOR AND LIVE FIRE COURSE
Name
Location
Phone Number
Live Fire Course
Bob Lounsbury Sporting Goods
Middletown, NY
(845)-343-1808
No
Collector Rifle & Ammo, Inc.
Hopewell Jct., NY
(845)-227-4100
No
Damon Finch Power Session
Kingston, NY
(845)-561-2250
Daniel M. Bartholomew
Middleburgh, NY
(518)-322-2045
Yes
Donahue Consulting LLC
Jefferson Valley, NY
(914)-471-5631
Donald Todd
Kingston, NY
(845)679-5625
Double Eagle Tactical Training, Inc
Coxsackie, NY
(518) 331-7691
Yes
Ed Barrett
New Paltz, NY
(914)-456-1528
Yes
Firearms Safety Group
Walden, NY
(845)-778-7320
Frank O’Dell
Walden, NY
(845)-778-5936
George Rogero
Washingtonville, NY
(845)-496-4020
No
James Korosi
Highland,
(845)629-0042
James Rapoli
(914)-474-2126
Joseph Ciarlanto
Wallkill, NY
(845)-562-1596
No
John Alderucci
Wallkill, NY
(914)-260-5656
Yes
John Metzger
(845)-339-2119
Ken Cooper
(845)-348-3464
Yes
Kevin Moore
Chester, NY
(845)-391-4142
Kirk Rowan
Chester, NY
(845)-637-0207
Litton Robert
Port Ewen, NY
(845)594-2952
Master Class Shooters
Monroe, NY
(845)-774-4867
Middletown Pistol/Rifle
Middletown, NY
(845)-355-1412
Mike Costello
Kingston, NY
(845)-478-6604
Nancy Cass
Gardiner, NY
(914)-475-5286
Yes
New Paltz Rod & Gun Club
New Paltz, NY
(845)-255-7586
Yes
Peter Madri
Grahamsville, NY
(845)-807-9164
RBR Firearms Safety(Robert Ridley)
Highland, NY
(845)-392-5522
Yes
Ridgeline Defense
Gardiner, NY
(845)-750-4790
Robert Clydesdale
Plattekill, NY
(845)-568-7588
Robert Zuleg
(845)-224-7419
Ruger Custom Guns
Kingston, NY
(845)-336-7106
No
Sadd Eyal
Purling, NY
(518)622-8590
Shawn Barry
Kingston, NY
(845)-590-5523
Sight On Target(Christopher Lendell)
Saugerties, NY
(845)-853-9938
Syed Shahzdad A. Shah
Phoenicia, NY
(845)- 605-2767
Yes
Terry L. Dieterle
Ulster Park, NY
(845)-658-2375
Thomas Sokota
Wallkill, NY
(845)-674-6963
Yes
Tyrone Vanamburgh
West Esopus, NY
(845)-389-5787
Vincent Dillard
Wawarsing, NY
(845)-532-6140
Yes
Vincent Nigro Jr.
Ellenville, NY
(845)-532-4755
Yes
Vincent Nigro Sr.
Accord, NY
(845)-389-1190
Yes
Vito Spagnola
Middletown, NY
(845)-406-1517
Yes
William &Maria Mann
Port Jervis, NY
(845)-858-4990
Yes
06/10/2020
Juan Figueroa
Sheriff
Eric V. Benjamin
Undersheriff
An Accredited Law Enforcement agency since 1990
Office of the
SHERIFF
Ulster County
Ulster County Law Enforcement Center
380 Boulevard, Kingston, NY 12401
www.co.ulster.ny.us/sheriff
Vincent V. Altieri
Captain /Criminal Division
Jerome M. John
Superintendent / Corrections Division
Jarrid E. Blades
Chief Civil Administrator
Area Code 845
Administration 340-3802
Criminal Division 338-3640
Corrections Division 340-3644
Civil Division 340-3643
Pistol Permits 340-3639
Crime Tips Hotline 340-3599
To All Pistol License Applicants
Please note: All prior arrests must be disclosed on your application forms. This includes any court
action that was dismissed, ACD, sealed by the court, or juvenile status.
A court disposition must be included for every arrest.
Failure to comply with these instructions will result in the declination of the pistol license
application.
ALL PRIOR ARRESTS MUST BE DISCLOSED
REGARDLESS OF THE DISPOSITION
By signing below the applicant acknowledges that he/she has read the foregoing and understands its
content. Applicant acknowledges that any false answer on the application constitutes the felony of
perjury.
Name (print):
Address:
Email: Cell Phone:
Business Phone: Residence Phone:
Applicant’s Signature:
Signed and sworn to me on this day of
Notary
NYS Firearms License Request for Public Records Exemption
Pursuant to section 400.00 (5) (b) of the NYS Penal Law
I am: [ ] an applicant for a firearms license [ ] currently licensed to possess a firearm in NYS
Name ____________________________________________ Date of Birth_____________________
Address_________________________________________ City_________________ State________
Firearms License # (if applicable) ____________________________ Date Issued________________
Licensing Authority / County of Issuance or Application _____________________________________
I hereby request that any information concerning my firearms license application or firearms
license not be a public record. The grounds for which I believe my information should NOT be
publicly disclosed are as follows: (check all that are applicable)
[ ] 1. My life or safety may be endangered by disclosure because:
[ ] A. I am an active or retired police officer, peace officer, probation officer, parole officer, or
corrections officer;
[ ] B. I am a protected person under a currently valid order of protection;
[ ] C I am or was a witness in a criminal proceeding involving a criminal charge;
[ ] D. I am participating or previously participated as a juror in a criminal proceeding, or am or was a
member of a grand jury;
[ ] 2. My life or safety or that of my spouse, domestic partner or household member may be endangered by
disclosure for some other reason explained below: (Must be explained in item 5 below)
[ ] 3. I am a spouse, domestic partner or household member of a person identified in A, B, C or D of question 1.
(Please check any that apply)
A _____ B_____ C_____ D_____
[ ] 4. I have reason to believe that I may be subject to unwarranted harassment upon disclosure.
5. (Please provide any additional supportive information as necessary)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I understand that false statements made herein are punishable as a class A misdemeanor. I further
understand that upon discovery that I knowingly provided any false information, I may be subject
to criminal penalties and that this request for an exemption shall become null and void.
_____________________________________________________ ________________________
Signature Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PLEASE READ ALL INSTRUCTIONS CAREFULLY (County of Ulster)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document