Get Pa Sp 4-127 2024-2025

SP 4-127 4-2019 COMMONWEALTH OF PENNSYLVANIA RENEWAL COUNTY OF APPLICATION FOR A PENNSYLVANIA LICENSE TO CARRY FIREARMS FOR USE BY ISSUING AUTHORITY PICS Temp App. No License No. Rejection Date PICS Perm. App. No. Temporary License Approval Date Application Date Permanent License Approval Date Reason for Rejection Signature 1. LAST NAME 2. JR* ETC. 7a* DATE OF BIRTH 7b. PLACE OF BIRTH 3. FIRST NAME 8. SOCIAL SECURITY NUMBER Optional 16. STREET ADDRESS 4. MIDDLE NAME 9. AGE 10. SEX 11. RACE 17. CITY 5. PHOTO ID/DRIVER LICENSE NO. 12. HEIGHT 13. WEIGHT 14. HAIR COLOR 18. STATE 19. ZIP CODE 6. STATE 15. EYE COLOR 20. HOME TELEPHONE NO. 21. EMPLOYER/BUSINESS NAME 22. WORK TELEPHONE NO. 24. ADDRESS - 23. OCCUPATION 25. CITY 27. ZIP CODE 28. REASON FOR A LICENSE TO CARRY FIREARMS SELF-DEFENSE EMPLOYMENT HUNTING/FISHING TARGET SHOOTING GUN COLLECTING OTHER 29. TWO REFERENCES NOT FAMILY MEMBERS NAME TELEPHONE NO. APPLICANTS ARE DETERMINED TO BE ELIGIBLE FOR A LICENSE TO CARRY FIREARMS BASED UPON CRITERIA SET FORTH WITHIN THE PENNSYLVANIA UNIFORM FIREARMS ACT 18 PA. C. S* CHAPTER 61 6105 DEALING WITH INDIVIDUALS NOT TO POSSESS FIREARMS AND 6109 DEALING WITH THE ISSUANCE OF A LICENSE TO CARRY FIREARMS* DO YOU MEET ANY OF THE FOLLOWING PROHIBITING CRITERIA UNDER 18 PA. C. S* EACH QUESTION 6109 e 1 CHECK YES OR NO IN THE BOX BY A. IS YOUR CHARACTER AND REPUTATION SUCH THAT YOU WOULD BE LIKELY TO ACT IN A MANNER DANGEROUS TO PUBLIC SAFETY B. HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE UNDER THE ACT OF APRIL 14 1972 P. L* 233 NO. 64 KNOWN AS THE CONTROLLED SUBSTANCE DRUG DEVICE AND COSMETIC ACT CSDDCA AS PROVIDED IN 18 PA. C. S* 6109 e 1 II ANY PENNSYLVANIA DRUG CONVICTION UNDER THE CSDDCA IS PROHIBITING FOR A LICENSE TO CARRY. YES NO C. 6105 c APPLY TO YOU READ INFORMATION ON BACK PRIOR TO ANSWERING D. THE CONTROLLED SUBSTANCE DRUG DEVICE AND COSMETIC ACT 6105 OR FOR AN OFFENSE UNDER E* CONDITION OR OTHER TREATMENT OR ADJUDICATED INCOMPETENT/INCAPACITATED F* ARE YOU AN INDIVIDUAL WHO IS A HABITUAL DRUNKARD OR WHO IS ADDICTED TO OR AN UNLAWFUL USER OF MARIJUANA OR A STIMULANT DEPRESSANT OR NARCOTIC DRUG G* ARE YOU NOW CHARGED WITH OR HAVE YOU EVER BEEN CONVICTED OF A CRIME PUNISHABLE BY IMPRISONMENT FOR A TERM EXCEEDING ONE YEAR THIS IS THE MAXIMUM SENTENCE YOU COULD HAVE RECEIVED NOT THE ACTUAL SENTENCE YOU DID RECEIVE* IT DOES NOT INCLUDE FEDERAL OR STATE OFFENSES PERTAINING TO ANTITRUST UNFAIR TRADE PRACTICES RESTRAINTS OF TRADE OR REGULATION OF BUSINESS OR STATE OFFENSES CLASSIFIED AS MISDEMEANORS AND PUNISHABLE BY A TERM OF IMPRISONMENT NOT EXCEEDING TWO YEARS* H. I. ARE YOU A FUGITIVE FROM JUSTICE THIS DOES NOT APPLY TO MOVING OR NONMOVING SUMMARY OFFENSES UNDER TITLE 75 RELATING TO MOTOR VEHICLES. J* ARE YOU PROHIBITED FROM POSSESSING OR ACQUIRING A FIREARM UNDER THE STATUTES OF THE UNITED STATES ARE YOU A UNITED STATES CITIZEN IF NO COUNTRY OF BIRTH COUNTRY OF CITIZENSHIP ALIEN REGISTRATION OR I-94 IF YOU ARE A RESIDENT OF ANOTHER STATE DO YOU POSSESS A CURRENT LICENSE PERMIT OR SIMILAR DOCUMENT TO CARRY A FIREARM ISSUED BY THAT STATE IF YES ATTACH A PHOTOCOPY OF THE DOCUMENT TO THIS FORM.