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Free New York Rifle Shotgun Permit Application - PDF Form Download

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Form PD 641-040, New York Rifle Shotgun Permit Application is an instrument intended to facilitate the procurement of a rifle/shotgun permit within the jurisdiction of New York State. Complete the application with black/blue ink by typing or printing.


Submit four photos and other supporting documents along with the application for further processing at Rifle/Shotgun Section, Kew Gardens, New York. Separate fee remittance of $140 and $91.50 is necessary. Carrying the SSN card is mandatory during the filing of the application. Fill form PD 641-030, PD 641-040A, Arrest Information, 38 RCNY 5-33, Affidavit of Co-Habitant, and Acknowledgement of Person Agreeing to Safeguard Firearm(s) along with the form PD 641-040 and submit in person to License Division, Rifle / Shotgun Section, Kew Gardens, New York.


PD 641-040 Application -Rifle / Shotgun Permit

Affix 4 full-face photographs, then enter your last, first, middle name followed by SSN, legal address, city, state, and zip code. Provide the apartment number, floor, and residential precinct. Then select if you are US citizen or alien and specify Alien Registration Number if you select alien. Furnish gender, date of birth, height, weight, hair and eye color, place of birth, and occupation in the respective fields. Insert employer name and address along with daytime and residential phone number.

Select yes for conviction if any, and provide date of arrest, city/state of the arrest, charge, and particulars of disposition or sentence for each felony or select no otherwise. Select applicable responses for the next 6 questions. Furnish previous permit number and expiry date in question 1 if applicable. Select theatrical permits if any among four choices and describe the purpose and name of production/company on the following lines. Mention your name and sign in the space provided to complete the form PD 641-040 Application-Rifle/Shotgun Permit.

New York Rifle Shotgun Permit Application

PD 641-030 Information Request Waiver of Confidentiality

Enter last, first, and middle name followed by SSN, address, apartment/floor, city, state, and zip code. Specify home and daytime business phone number then name of employer, occupation, and employer address. Continue with furnishing date and place of birth, height, weight, eyes and hair color in the respective spaces. Mention your name, address, and date, then sign on the space offered to complete PD 641-030 Information Request Waiver of Confidentiality form. Inputs for the remainder of the form are required from Rifle/Shotgun Section.

PD 641-040A Rifle/Shotgun Application Package Insert

Read the information furnished in PD 641-040A Rifle/Shotgun Application Package Insert and comply with the same while submitting the application form.

Arrest Information

Your signature before the Notary Public of New York State is necessary on Arrest Information form in acceptance if you marked yes in response to question number 1 in Form PD 641-040, New York Rifle Shotgun Permit Application. Insert date after your signature. Complete the form with the date, sign, and seal by the Notary Public.

38 RCNY 5-33 Affirmation Of Familiarity With Rules And Law

Form 38 RCNY 5-33 Affirmation of Familiarity with Rules and Law seeks the input of the license number, date, signature, and printed name.

Affidavit of Co-Habitant

Type a name of the county followed by the name and address of the affidavit maker in the respective spaces. Continue by entering the name of the applicant, relationship with the applicant along with home, work, and cell phone numbers. Sign before the Notary Public followed by the inputs like date, seal, and signature of the Notary Public.

Acknowledgement of Person Agreeing to Safeguard Firearm(s)

Start by entering applicant/licensee name and application/license number. Print your last, first, and middle name followed by address, number and street name, apartment, city, state, and zip code. Insert home, cell, and work phone numbers on the next line. Print your name, followed by your signature and date in acceptance of Acknowledgement of Person Agreeing to Safeguard Firearm(s). Name and signature of a witness are required to complete the form.

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New York Rifle Shotgun Permit Application

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