PPB-3 (Rev 08/22)
State of New York
Personal Information
Last Name First Name Middle Name
Street Name (Physical Address) Apt # City State Zip
Mailing Address (If Different than Physical) Apt # City State Zip
Sex: DOB: Height: ft in Weight: Hair: Eyes:
Social Security Number:
Pistol/Revolver License Application
Semi-Automatic Rifle License Application
NYSID # License # County of Issue
Date of Issue Expiration Date
Suffix
Race:
NY Driver's License # (or Non-Driver ID)
Citizen of U.S. Primary Phone # Secondary Phone #
Email Address
Employed By Current Occupation
Nature of Business
Business Address
Apt # City State Zip
I hereby apply for a Pistol/Revolver License to: (Check only one)
Carry Concealed
*Possess on Premises
*Possess/Carry
During Employment
(*) Premise Address or Employer Name and Address must be provided below:
Employer Name (If Carry During Employment) Address or Other Location (Street #, Street Name, Apartment Number, City, State, Zip Code)
I hereby apply for a Semi-Automatic Rifle License: (Check Yes or No)
Yes
No
Give four character references who by their signature attest to your good moral character:
Last, First, MI
Street Address (Street #, Name, Apartment #, City, State, Zip Code)
Signature
Complete the form in its entirety. Fields that are not fillable must be hand written/signed.
THIS SECTION TO BE COMPLETED BY LICENSING OFFICE
In accordance with the Federal Privacy Act of 1974, you are hereby notified that your Social Security Number is not mandated by law. It is
required by the Pistol Permit Bureau as part of the standard for recording Firearms. Failure to disclose your Social Security Number will
prohibit your transaction from being recorded. The State Police will release your Social Security Number only for reasons required by law
or with your written consent.
Marital Status and Relationships-THIS SECTION ONLY APPLIES TO CARRY CONCEALED
CURRENT MARRIAGE OR RELATIONSHIP
What is the Applicant’s current relationship status?
If applicable, provide the requested information regarding the Applicant’s current relationship below.
Last Name First Name M.I. Maiden Name (If Applicable) DOB
PPB-3 (Rev 08/22) New York State Police
State of New York
Pistol/Revolver License Application
Semi-Automatic Rifle License Application
Phone Number
ADULTS RESIDING IN HOME, INCLUDING ADULT CHILDREN
First Name M.I. Maiden Name (If Applicable) DOB
Phone Number
Last Name First Name M.I. Maiden Name (If Applicable) DOB
Phone Number
Last Name First Name M.I. Maiden Name (If Applicable) DOB
Phone Number
Social Media Accounts-THIS SECTION ONLY APPLIES TO CARRY CONCEALED
LIST FORMER AND CURRENT SOCIAL MEDIA ACCOUNTS FOR THE PAST THREE YEARS
Last Name
Yes No
Part Time
Full TimeIf, yes:
Do minors reside within the residence?
Arrest Date
Are you a fugitive from justice?
Are you an unlawful user of or addicted to any controlled substance as defined in section 21 U.S.C. 802?
Are you an alien admitted to the United States who does not qualify for the exceptions under 18 U.S.C. 922 (y)(2)?
Have you been discharged from the Armed Forces under dishonorable conditions?
Have you ever renounced your United States citizenship?
Have you ever suffered any mental illness?
Have you ever been involuntarily committed to a mental health facility?
Have you ever had a pistol / revolver / semi-automatic rifle license revoked?
Are you under any firearms suspension or ineligibility order issued pursuant to the provisions of section 530.14 of the
criminal procedure law or section eight hundred forty-two-a of the family court act?
Have you had a guardian appointed for you pursuant to any provision of state law, based on a determination that as a result
of marked subnormal intelligence, mental illness, incapacity, condition or disease you lack the mental capacity to contract or
manage your own affairs?
Have you been convicted of Assault 3rd, Misdemeanor DWI, or Menacing 3rd within the previous five years?
*THIS QUESTION ONLY APPLIES TO CARRY CONCEALED
Are you prohibited from possessing firearms under federal law, including having been convicted in any court of a
misdemeanor crime of domestic violence or being under indictment for a crime punishable by imprisonment for a term
exceeding one year?
If the answer to any of the questions above is YES, explain here:
Are you an alien illegally or unlawfully in the United States?
PPB-3 (Rev 08/22) New York State Police
State of New York
Pistol/Revolver License Application
Semi-Automatic Rifle License Application
Have you ever been arrested, summoned, charged or indicted anywhere for any offense, including DWI (except traffic infractions)?
Yes
No
If yes, furnish the following information:
Police Agency
Charge Disposition Date
Disposition Court
Disposition
For applicants under twenty-one years of age only:
Have you been honorably discharged from the United States Army, Navy, Marine Corps, Air Force or Coast Guard, or the
National Guard of the State of New York?
Sealed arrests must be included. *Refer to Executive Law §296(16)
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
PPB-3 (Rev 08/22) New York State Police
State of New York
Pistol/Revolver License Application
Semi-Automatic Rifle License Application
Photograph
Of Applicant
Taken Within 30 Days
Full Face Only
Knowingly providing false information will be sufficient cause to deny this application and
constitutes a crime punishable by fine, imprisonment, or both. I am aware that the following
conditions affect any license which may be issued to me:
1. No license issued as a result of this application is valid in the City of New York.
2. Any pistol/revolver license issued as a result of this application will be valid only for a pistol or revolver specifically
described in the license properly issued by the licensing officer.
3. If I permanently change my address, notice of such change and my new address must be forwarded to the
Superintendent of the State Police and in Nassau County and Suffolk County, to the licensing officer of that county,
within 10 days of such change.
4. Any license issued as a result of this application is subject to revocation at any time by the licensing officer or any
judge or justice of a court of record.
, 20
, New York
Signature of Applicant
Signature of Officer Administering Oath Title of Officer
APPLICATION NOT VALID UNLESS SWORN
day of
This
at
Jurat:
Signed and sworn to me before
Investigation Report – All information provided by this applicant has been verified:
Name Rank Organization
Signature of Investigating Officer
This application is
The following restriction(s) is (are) applicable to this license:
Title and Signature of Licensing Officer
Rank Organization
Approved
Disapproved
Fingerprints submitted electronically by:
Name
Date Submitted
Manufacturer
If Licensing Officer authorizes the possession of a pistol, revolver or single shot firearm(s) at the time of issue of original license, furnish the
following information:
Pistol/Revolver/
Single Shot
Model
Frame Only
Caliber(s)
Serial Number
Property of
Duplicate of this application must be filed with the Superintendent of State Police within 10 days of issuance as required by Penal Law Section
400.00 SUBD.5.
This form is approved by Superintendent of the State Police as required by Penal Law section 400.00, SUBD. 3.
***List handguns only, do not list semi-automatic rifles.
