Form DPS-799-C "Pistol Permit/Eligibility Certificate Application" - Connecticut

What Is Form DPS-799-C?

This is a legal form that was released by the Connecticut Department of Emergency Services and Public Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 28, 2018;
  • The latest edition provided by the Connecticut Department of Emergency Services and Public Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DPS-799-C by clicking the link below or browse more documents and templates provided by the Connecticut Department of Emergency Services and Public Protection.

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Download Form DPS-799-C "Pistol Permit/Eligibility Certificate Application" - Connecticut

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STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Special Licensing and Firearms Unit
PISTOL PERMIT/ELIGIBILITY CERTIFICATE APPLICATION
(Pursuant to C.G.S. §§ 29-28 et. seq., 29-36 et. seq., and 53a-217 et. seq.
Before completing this application, it is suggested that you review the Connecticut General Statutes pertaining to
firearms. These can be accessed on the Internet at www.cga.ct.gov. or through your local library.
Type of Permit Requested:
Check Box:
60 Day Temporary State Pistol Permit
Non-Resident State Pistol Permit
Eligibility Certificate to Purchase Pistols or Revolvers
Eligibility Certificate to Purchase Long Guns
Instructions:
Instructions for Eligibility
Instructions for Non-Resident
Certificates to Purchase Pistols
State Pistol Permits:
Instructions for State Pistol Permits:
or Revolvers and/or Eligibility
Certificates to Purchase Long
Guns:
1. Complete this form (DPS-799-C) and submit to
**CALL DESPP FOR PACKET**
1. Complete this form and submit in
appropriate local authority (local police, resident
person at DESPP Headquarters,
You must hold a valid permit or
state trooper or first select person, as applicable)
Division of State Police, located at
license to carry a pistol or revolver
along with all of the following:
1111 Country Club Road,
issued by a recognized United States
Middletown, Connecticut along with
jurisdiction.
 Firearms Safety & Use Course Certificate;
the below:
 $70.00, fee, payable to the local authority;
Complete this form and submit to
and
DESPP, Division of State Police, pistol
Firearms Safety & Use Course
 Proof you are legally and lawfully in the
permit location along with all of the
Certificate;
United States (e.g., certified copy of birth
following:
$35.00 fee, payable to
certificate, U.S. passport or documentation
Treasurer, State of
 Completed State of CT and Federal
issued by I.C.E.).
Connecticut;
fingerprint card with $75.00 fee and
Application for a State Eligibility
2. Submit fingerprints for a criminal history check
$13.25 fee, payable to Treasurer,
Certificate for a Pistol or
through a law enforcement agency. Fees include
State of Connecticut for criminal
Revolver or for Long Guns
a $75.00 fee and a $13.25 fee, payable at the
history background checks;
(DPS-164-C);
 Firearms Safety & Use Course
agency where the prints are taken. Fees must be
Proof you are legally and
paid by separate checks.
Certificate;
lawfully in the United States
 $70.00 fee, payable to Treasurer,
3. Upon approval, the local authority will issue a
(e.g., certified copy of birth
State of Connecticut;
Temporary State Permit to Carry Pistols and
certificate, U.S. passport or
 Completed Application for State
Revolvers (DPS-11-C), effective for 60 days.
documentation issued by
Permit to Carry Pistols and Revolvers
I.C.E.); and
form (DPS-46-C);
4. Within the 60 day period, go to a DESPP,
Proof of valid state issued photo
 Completed DPS-129-C signed and
Division of State Police, pistol permit location and
identification card.
notarized and 2x2 color photograph
submit the following:
(passport style);
2. Submit fingerprints for a criminal
 The Temporary State Permit to Carry Pistols
 Copy of the permit or license to carry
history check through a law
and Revolvers (DPS-11-C) issued by the
a pistol or revolver issued to you by a
enforcement agency. Fees include a
local authority;
recognized United States jurisdiction;
$75.00 fee and a $13.25 fee, payable
 A completed Application for State Permit to
 Proof you are legally and lawfully in
at the agency where the prints are
Carry Pistols and Revolvers (DPS-46-C);
the United States (e.g., certified copy
taken. Fees must be paid by separate
 $70.00 fee, payable to Treasurer, State of
of birth certificate, U.S. passport or
checks.
Connecticut;
documentation issued by I.C.E.);and
 Proof you are legally and lawfully in the
3. Upon approval, your photograph will
 Proof of valid state issued photo
United States (e.g., certified copy of birth
be taken at DESPP and you will be
identification card.
certificate, U.S. passport or documentation
issued an eligibility certificate.
Out of State Pistol Permit Information:
issued by I.C.E.); and
 Proof of valid state issued photo identification
State of Issue: _______________
card.
Expiration Date: _____________
5. Upon approval, your photograph will be taken at
Permit Number: ______________
DESPP and you will be issued a state pistol permit.
For Department of Emergency Services and Public Protection (DESPP), Division of State Police, pistol permit locations, access
www.ct.gov/despp
and follow the link to the Special Licensing and Firearms Unit or call (860) 685-8290. Note: All payments must
.
be made with separate checks
Page 1 of 4
DPS-799-C (Rev. 12/28/18)
An Affirmative Action/Equal Employment Opportunity Employer
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Special Licensing and Firearms Unit
PISTOL PERMIT/ELIGIBILITY CERTIFICATE APPLICATION
(Pursuant to C.G.S. §§ 29-28 et. seq., 29-36 et. seq., and 53a-217 et. seq.
Before completing this application, it is suggested that you review the Connecticut General Statutes pertaining to
firearms. These can be accessed on the Internet at www.cga.ct.gov. or through your local library.
Type of Permit Requested:
Check Box:
60 Day Temporary State Pistol Permit
Non-Resident State Pistol Permit
Eligibility Certificate to Purchase Pistols or Revolvers
Eligibility Certificate to Purchase Long Guns
Instructions:
Instructions for Eligibility
Instructions for Non-Resident
Certificates to Purchase Pistols
State Pistol Permits:
Instructions for State Pistol Permits:
or Revolvers and/or Eligibility
Certificates to Purchase Long
Guns:
1. Complete this form (DPS-799-C) and submit to
**CALL DESPP FOR PACKET**
1. Complete this form and submit in
appropriate local authority (local police, resident
person at DESPP Headquarters,
You must hold a valid permit or
state trooper or first select person, as applicable)
Division of State Police, located at
license to carry a pistol or revolver
along with all of the following:
1111 Country Club Road,
issued by a recognized United States
Middletown, Connecticut along with
jurisdiction.
 Firearms Safety & Use Course Certificate;
the below:
 $70.00, fee, payable to the local authority;
Complete this form and submit to
and
DESPP, Division of State Police, pistol
Firearms Safety & Use Course
 Proof you are legally and lawfully in the
permit location along with all of the
Certificate;
United States (e.g., certified copy of birth
following:
$35.00 fee, payable to
certificate, U.S. passport or documentation
Treasurer, State of
 Completed State of CT and Federal
issued by I.C.E.).
Connecticut;
fingerprint card with $75.00 fee and
Application for a State Eligibility
2. Submit fingerprints for a criminal history check
$13.25 fee, payable to Treasurer,
Certificate for a Pistol or
through a law enforcement agency. Fees include
State of Connecticut for criminal
Revolver or for Long Guns
a $75.00 fee and a $13.25 fee, payable at the
history background checks;
(DPS-164-C);
 Firearms Safety & Use Course
agency where the prints are taken. Fees must be
Proof you are legally and
paid by separate checks.
Certificate;
lawfully in the United States
 $70.00 fee, payable to Treasurer,
3. Upon approval, the local authority will issue a
(e.g., certified copy of birth
State of Connecticut;
Temporary State Permit to Carry Pistols and
certificate, U.S. passport or
 Completed Application for State
Revolvers (DPS-11-C), effective for 60 days.
documentation issued by
Permit to Carry Pistols and Revolvers
I.C.E.); and
form (DPS-46-C);
4. Within the 60 day period, go to a DESPP,
Proof of valid state issued photo
 Completed DPS-129-C signed and
Division of State Police, pistol permit location and
identification card.
notarized and 2x2 color photograph
submit the following:
(passport style);
2. Submit fingerprints for a criminal
 The Temporary State Permit to Carry Pistols
 Copy of the permit or license to carry
history check through a law
and Revolvers (DPS-11-C) issued by the
a pistol or revolver issued to you by a
enforcement agency. Fees include a
local authority;
recognized United States jurisdiction;
$75.00 fee and a $13.25 fee, payable
 A completed Application for State Permit to
 Proof you are legally and lawfully in
at the agency where the prints are
Carry Pistols and Revolvers (DPS-46-C);
the United States (e.g., certified copy
taken. Fees must be paid by separate
 $70.00 fee, payable to Treasurer, State of
of birth certificate, U.S. passport or
checks.
Connecticut;
documentation issued by I.C.E.);and
 Proof you are legally and lawfully in the
3. Upon approval, your photograph will
 Proof of valid state issued photo
United States (e.g., certified copy of birth
be taken at DESPP and you will be
identification card.
certificate, U.S. passport or documentation
issued an eligibility certificate.
Out of State Pistol Permit Information:
issued by I.C.E.); and
 Proof of valid state issued photo identification
State of Issue: _______________
card.
Expiration Date: _____________
5. Upon approval, your photograph will be taken at
Permit Number: ______________
DESPP and you will be issued a state pistol permit.
For Department of Emergency Services and Public Protection (DESPP), Division of State Police, pistol permit locations, access
www.ct.gov/despp
and follow the link to the Special Licensing and Firearms Unit or call (860) 685-8290. Note: All payments must
.
be made with separate checks
Page 1 of 4
DPS-799-C (Rev. 12/28/18)
An Affirmative Action/Equal Employment Opportunity Employer
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Contact / Identifying Information:
Name of Applicant
,
.
Last
Suffix
.
First
Middle Initial
Provide all other names by which you have been known (Maiden name, Aliases, Nicknames, etc.)
(Attach additional sheet(s), if necessary)
Date of Birth
Sex
Height
Weight
Eye Color
/
/
.
Brown
Blue
Black
F
M
Ft.
In.
Lbs
Green
Gray
Hazel
Month/Day/Year
Race
Hair Color
Brown
Black
Blonde
Red
hite
American Indian/Alaskan Native
Asian/Pacific Islander
W
Gray
White
Bald
Black
Unknown
Other
Place of Birth
Social Security Number
(Optional, but will help
prevent misidentification)
,
-
-
City/Town
State
Country of Citizenship
Alien Reg. Number (If applicable)
Residential Address (List street address. Post office box numbers are not acceptable)
Number/Street
,
-
City/Town
State
Zip Code
List Residential Addresses for the Last 7 Years (Attach additional sheet(s), if necessary)
*Any subsequent changes of address must be reported within 48 hours to the Special Licensing and Firearms Unit
1. ___________________________________________________________________________________________
2. ___________________________________________________________________________________________
Mailing Address (If different from current residential address above)
Number/Street
,
-
City/Town
State
Zip Code
Motor Vehicle Operator’s License Number
Home Telephone Number
(
)
-
Area Code
State of Issue
Alternate Telephone Number
(
)
-
Area Code
Employment History:
List Employers for the Last 7 Years (Provide employer’s name, address and telephone number)
(Attach additional sheet(s), if necessary)
__________________________________________________________________________________
1.
2. ___________________________________________________________________________________________
Permit or Eligibility Certificate History:
Have you had a firearms permit, permit application or eligibility certificate of any kind from ANY jurisdiction in the
United States denied, suspended or revoked?
NO
YES
If "YES,” provide:
1. Identify the jurisdiction which issued the denial, suspension or revocation: ___________________
2. Date of denial, suspension or revocation: _______________________________________________
3. The reason for the denial, suspension or revocation:______________________________________
Page 2 of 4
DPS-799-C (Rev. 12/28/18)
An Affirmative Action/Equal Employment Opportunity Employer
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Medical History:
Have you been confined in a hospital for mental illness in the past sixty (60) months by order of a Probate Court?
NO
YES
If "YES," explain: (Attach additional sheet(s), if necessary)
Have you been discharged from custody within the past twenty years after having been found not guilty of a crime
by reason of a mental disease or defect?
NO
YES
If "YES," explain: (Attach additional sheet(s), if necessary)
Have you been voluntarily admitted to a hospital for mental illness within the past six (6) months for reasons other
than solely for alcohol or drug dependence?
NO
YES
If "YES," explain: (Attach additional sheet(s), if necessary)
Notice: DESPP herein notifies the applicant that, pursuant to C.G.S. §§ 29-28 through 29-38b, DESPP will be notified by the
Department of Mental Health and Addiction Services if the applicant has been confined to a hospital for psychiatric
disabilities within the preceding sixty (60) months by order of Probate Court, or if the applicant has been voluntarily admitted
to a hospital for mental illness within the past six (6) months for reasons other than solely for alcohol or drug dependence.
Criminal History:
Have you ever been ARRESTED for any crime, in any jurisdiction?
NO
YES If "YES," list all arrests, indicating
charges, locations, dates of arrest and dispositions. (Attach additional sheet(s), if necessary)
Notice: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have
been erased pursuant to C.G.S. §§46b-146, 54-76o, or 54-142a. If your criminal records have been erased pursuant to one
of these statutes, you may swear under oath that you have never been arrested. Criminal records that may be erased are
records pertaining to a finding of delinquency or that a child was a member of a family with service needs (C.G.S. 46b-146),
an adjudication as a youthful offender (C.G.S. 54-76o), a criminal charge that has been dismissed or nolled, a criminal
charge for which the person has been found not guilty, or a conviction for which the person received an absolute pardon
(C.G.S. 54-142a).
With regard to criminal history information arising from jurisdictions other than the State of Connecticut: You are not required
to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to the
law of the other jurisdiction. Additionally, you are not required to disclose the existence of an arrest arising from another
jurisdiction if you are permitted under the law of that jurisdiction to swear under oath that you have never been arrested.
Have you ever been CONVICTED under the laws of this state, federal law or the laws of another jurisdiction?
YES
If "YES,” list all convictions, include charges, location, date of arrest, and disposition. (Attach additional
NO
sheet(s), if necessary)
Are you currently on probation, parole, work release, in an alcohol and/or drug treatment program or other pre-trial
diversionary program or currently released on personal recognizance, a written promise to appear or a bail bond for
a pending court case?
NO
YES
If "YES," explain. (Attach additional sheet(s), if necessary)
Within the past five (5) years, have you been the subject of a Protective Order or Restraining Order issued by a
court in a case involving the use, attempted use or threatened use of physical force against another person,
regardless of the outcome or result of any related criminal case?
NO
YES
If “YES,” which court issued the order?
Military History:
Were you ever a member of the Armed Forces of the United States?
NO
YES (If yes, please include a copy of your DD-214)
Were you ever discharged from the Armed Forces of the United States with a less than Honorable Discharge?
NO
YES
Page 3 of 4
DPS-799-C (Rev. 12/28/18)
An Affirmative Action/Equal Employment Opportunity Employer
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Proof of Training:
*Attach a copy of the letter or certificate attesting that you have completed a course in the safety and use of pistols and
revolvers or long guns (as appropriate, depending upon which permit or certificate you are requesting), signed by the
instructor of the course.
Instructor: (Check applicable box)
National Rifle Association
Department of Energy and Environmental Protection (DEEP)
Other: ___________________________________
State Instructor's Name and ID Number:_______________________________________________________
Declaration:
I understand that any false statement herein, which I do not believe to be true and which is intended to mislead a public
servant in the performance of his or her official function, is punishable by law (See CGS § 53a-157b). I further understand
that any statement in this application that is determined to be false or inaccurate shall constitute grounds for the denial of
such application. If approved before the facts are known, such approval shall be void if based on a false or inaccurate
statement. My signature below attests to the accuracy, completeness and to the truth of all information supplied on this
application:
I declare, under the penalties of false statement, that the answers to the above are true and correct.
Date ____________________
Signed
STATE OF
Print Name
COUNTY OF _______________
Subscribed and sworn to before me this ______ day of
20_____
Name:
Notary Public
My Commission Expires:
Commissioner of Superior Court
NOTICE: Appeal Process for Permits
In the event that your application for pistol permit or eligibility certificate is denied or revoked, you may notify the
th
Board of Firearm Permit Examiners, at 20 Trinity St., 5
Floor, Hartford, CT 06106. Telephone: (860)256-2977
OR (860) 256-2947, in writing, within ninety (90) days, in order to begin your appeal process. At a hearing
before the Board, you may request that your application be reconsidered or that your permit or eligibility
certificate be reinstated.
For Official Use Only:
Application Received:
Application Status:
FBI Sent:
No
Yes
FBI Reply:
No
Yes
/
/
Approved
Denied
ICE Response:
No
Yes
Month/Day/Year
DMHAS:
No
Yes
SPBI:
No
Yes
(Signature and title of issuing authority)
Number :
Page 4 of 4
DPS-799-C (Rev. 12/28/18)
An Affirmative Action/Equal Employment Opportunity Employer
Page of 4