Form DSSP221 "Agency Application for Renewal of Private Investigative, Security Guard or Bail Recovery License" - New Hampshire

What Is Form DSSP221?

This is a legal form that was released by the New Hampshire Department of Safety - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the New Hampshire Department of Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DSSP221 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Safety.

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Download Form DSSP221 "Agency Application for Renewal of Private Investigative, Security Guard or Bail Recovery License" - New Hampshire

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DEPARTMENT OF SAFETY
DIVISION OF STATE POLICE
Agency Application for Renewal of Private Investigative, Security Guard
or Bail Recovery License
PLEASE CHECK ALL THAT APPLY:
Security Guard Agency
Private Investigator Agency
Bail Recovery Agency
Please add the following fees for EACH AGENCY RENEWAL:
$500.00 per license.
$25.00 for Criminal Record check Pursuant to RSA 106-F:8,III and Saf-C 2205.02.
$10.00 for Background Investigation pursuant to RSA 106-F:8,III and Saf-C 2205.03
1. Name of Agency:
Date:
2. Address of Agency:
Street
City
State
Zip Code
Telephone:
3. Local Branch Address:
Street
City
State
Zip Code
4. Mailing Address(if different)
Street
City
State
Zip Code
Telephone:
Manager:
5. Names and addresses of all partners, officers and major stockholders and their official titles:
6. Date previous license issued:
Number:
7. Name of person making application:
Date of Birth:
8. Present residence:
9. Have you ever been arrested for a crime in this or any other state or nation that has not been adjudicated, or convicted
of a crime that has not been annulled by the court? (except traffic violations).
YES
NO
10. Have you ever been convicted of a felony or misdemeanor associated with fraud, deceit, misrepresentation or a felony of
any type, or a misdemeanor associated with theft, dishonesty, physical assault violation of a protective order, abuse of
any type, or use or sale of illegal drugs in New Hampshire, or any other jurisdiction in the United States, its possessions
or territories?
YES
NO
11. Are you currently the subject of an active domestic violence Protective Order in New Hampshire or any other jurisdiction
in the United States, it’s possessions, or territories?
YES
NO
NOTE: If YES to questions #8, 9 or 10 you are required to give details below. (Continue on back if needed)
12. Physical characteristics:
Height
Weight
Color Hair
Color Eyes
I certify that I have read the following application and affirm that every statement contained herein is true and
correctly set forth and I also certify that I am familiar with all state laws, regulations and local ordinances relating
to the license for which I am applying, for the locations in which I intend to conduct operations.
Signature of Applicant:
(False statements punishable under N.H. RSA 641:13)
Application must be submitted with; (1) 2-year bond as required by RSA 106:F:9; (2) Correct fee for each agency
license; and (3) Application completed in full and legible.
EMAIL ADDRESS:
By providing an email address, you are acknowledging that the Permits and Licensing Unit may handle your application in
whole or part via electronic mail.
MAKE CHECKS PAYABLE TO: STATE OF N.H. – TREASURER
DSSP221 (Rev 3/18)
1
DEPARTMENT OF SAFETY
DIVISION OF STATE POLICE
Agency Application for Renewal of Private Investigative, Security Guard
or Bail Recovery License
PLEASE CHECK ALL THAT APPLY:
Security Guard Agency
Private Investigator Agency
Bail Recovery Agency
Please add the following fees for EACH AGENCY RENEWAL:
$500.00 per license.
$25.00 for Criminal Record check Pursuant to RSA 106-F:8,III and Saf-C 2205.02.
$10.00 for Background Investigation pursuant to RSA 106-F:8,III and Saf-C 2205.03
1. Name of Agency:
Date:
2. Address of Agency:
Street
City
State
Zip Code
Telephone:
3. Local Branch Address:
Street
City
State
Zip Code
4. Mailing Address(if different)
Street
City
State
Zip Code
Telephone:
Manager:
5. Names and addresses of all partners, officers and major stockholders and their official titles:
6. Date previous license issued:
Number:
7. Name of person making application:
Date of Birth:
8. Present residence:
9. Have you ever been arrested for a crime in this or any other state or nation that has not been adjudicated, or convicted
of a crime that has not been annulled by the court? (except traffic violations).
YES
NO
10. Have you ever been convicted of a felony or misdemeanor associated with fraud, deceit, misrepresentation or a felony of
any type, or a misdemeanor associated with theft, dishonesty, physical assault violation of a protective order, abuse of
any type, or use or sale of illegal drugs in New Hampshire, or any other jurisdiction in the United States, its possessions
or territories?
YES
NO
11. Are you currently the subject of an active domestic violence Protective Order in New Hampshire or any other jurisdiction
in the United States, it’s possessions, or territories?
YES
NO
NOTE: If YES to questions #8, 9 or 10 you are required to give details below. (Continue on back if needed)
12. Physical characteristics:
Height
Weight
Color Hair
Color Eyes
I certify that I have read the following application and affirm that every statement contained herein is true and
correctly set forth and I also certify that I am familiar with all state laws, regulations and local ordinances relating
to the license for which I am applying, for the locations in which I intend to conduct operations.
Signature of Applicant:
(False statements punishable under N.H. RSA 641:13)
Application must be submitted with; (1) 2-year bond as required by RSA 106:F:9; (2) Correct fee for each agency
license; and (3) Application completed in full and legible.
EMAIL ADDRESS:
By providing an email address, you are acknowledging that the Permits and Licensing Unit may handle your application in
whole or part via electronic mail.
MAKE CHECKS PAYABLE TO: STATE OF N.H. – TREASURER
DSSP221 (Rev 3/18)
1