State of New Hampshire
DEPARTMENT OF SAFETY
DIVISION OF STATE POLICE
NON-RESIDENT PISTOL/REVOLVER LICENSE
RENEWAL APPLICANTS PLEASE COMPLETE: NH Pistol/Revolver License #: Expires
See instructions on back to properly complete this form. Incomplete application will be returned.
Name
Date of Application
Mailing Address:
Street Resident State License No.
City/Town
Driver’s License No.
State
Zip Social Security No.
Legal Address (If different from above):
Telephone No.
(optional)
(optional)
Date of Birth Place of Birth Original Renewal
Height Hair Sex
United States Citizen YES
/ NO
If NO, and residing in the United States, you
MUST provide the following:
FILE #:
Weight Eyes Race
AR
#:
Occupation:
COUNTRY OF CITIZENSHIP:
Present Employer:
Employer’s Address:
Previous Employer:
Address:
If you answer “ Yes” to any of the following questions, you must provide complete details on the reverse side of this form.
Have you ever had a permit or license to carry denied in this or any other state? Yes No
Have you ever been convicted of a felony, in this or any other state, which has not been annulled? Yes No
Are you an unlawful user of or addicted to any controlled substance? Yes No
Have you ever been convicted of a misdemeanor involving drugs or violence? Yes No
Have you ever
been adjudicated as a mental defective by a court or committed by a court to any
mental institution?
Yes No
Have you ever been convicted in any court of a misdemeanor crime of domestic violence? Yes No
REQUIRED: For what reason(s) do you make application to carry a pistol in New Hampshire? (see reverse side)
Name and Complet
e Mailing Address of three (3) references:
1. 2. 3.
(NAME) (NAME) (NAME)
(ADDRESS) (ADDRESS) (ADDRESS)
SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION
YOU MUST SIGN THIS APPLICATION: Read the following carefully before you sign. A false statement on any part of this application will be just cause for
refusal of any application of any license issued under the provisions of RSA:159 and is punishable under RSA 641:3.
I understand that any information I give may be investigated as allowed by law.
I consent to the release of information about my ability and fitness to carry a pistol/revolver by employers, schools, medical/
psychiatric services, law enforcement agencies, and other individuals and organizations, to my local police chief, his designee,
and/or authorized employees of the State of New Hampshire.
I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete and made in good faith.
Date
OFFICIAL USE ONLY:
Approved Denied
SIGNATURE OF APPLICANT:
DSSP260 (Rev 08/13)
(optional)
