Form SH850 "Application for License to Purchase, Own, Possess and/or Transport Explosives" - New York

What Is Form SH850?

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

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the New York State Department of Labor;
  • 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 fillable version of Form SH850 by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.

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Download Form SH850 "Application for License to Purchase, Own, Possess and/or Transport Explosives" - New York

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Division of Safety and Health
License and Certificate Unit
Harriman State Office Campus
Building 12, Room 161A
www.labor.ny.gov
Albany, NY 12240
license&certificate@labor.ny.gov
Application for License to Purchase, Own, Possess and/or Transport Explosives
(Not Valid in New York City)
You must provide personal information to complete this form. The authority to collect this information is found in the
New York State Labor Law. This information will be maintained and used to process the application you are filing with
the Division of Safety and Health License and Certificate Unit. Failure to provide this information may result in our
inability to process your application. Note: By signing this form, you are granting permission to the Commissioner of
Labor to provide access to your Unemployment Insurance benefit file.
Applicant’s Information
Last name:
First name:
Middle initial:
Social Security number:
Date of birth:
Mailing address:
City:
State:
Zip:
Email:
County:
Home phone number:
Cell phone number:
New York State Department of Motor Vehicles driver license or Identification number:
ATF license number:
Eye color:
Hair color:
Weight:
Pounds
Height:
Feet
Inches
Are you self-employed?
Yes
No
If working, are you:
an employee
a contractor
Will you transport?
Yes
No
Business Information
Company for whom this application is being filed:
What is the nature of the business or organization?
What is your title?
Business address:
County:
Federal Employment Identification Number (FEIN):
Business phone:
New York State Unemployment Insurance Employer Registration number:
Purpose for which explosives will be used, check one:
 Construction
 Excavation
 Demolition
 Black powder
 Fireworks/Pyrotechnics
 Other
Explain:
SH 850 (07/19)
Page 1 of 3
Division of Safety and Health
License and Certificate Unit
Harriman State Office Campus
Building 12, Room 161A
www.labor.ny.gov
Albany, NY 12240
license&certificate@labor.ny.gov
Application for License to Purchase, Own, Possess and/or Transport Explosives
(Not Valid in New York City)
You must provide personal information to complete this form. The authority to collect this information is found in the
New York State Labor Law. This information will be maintained and used to process the application you are filing with
the Division of Safety and Health License and Certificate Unit. Failure to provide this information may result in our
inability to process your application. Note: By signing this form, you are granting permission to the Commissioner of
Labor to provide access to your Unemployment Insurance benefit file.
Applicant’s Information
Last name:
First name:
Middle initial:
Social Security number:
Date of birth:
Mailing address:
City:
State:
Zip:
Email:
County:
Home phone number:
Cell phone number:
New York State Department of Motor Vehicles driver license or Identification number:
ATF license number:
Eye color:
Hair color:
Weight:
Pounds
Height:
Feet
Inches
Are you self-employed?
Yes
No
If working, are you:
an employee
a contractor
Will you transport?
Yes
No
Business Information
Company for whom this application is being filed:
What is the nature of the business or organization?
What is your title?
Business address:
County:
Federal Employment Identification Number (FEIN):
Business phone:
New York State Unemployment Insurance Employer Registration number:
Purpose for which explosives will be used, check one:
 Construction
 Excavation
 Demolition
 Black powder
 Fireworks/Pyrotechnics
 Other
Explain:
SH 850 (07/19)
Page 1 of 3
Related Experience
Employer’s name (include self-employment):
Employer’s address:
Dates of employment (M/Y):
Start:
To:
Describe your job duties. Attach additional sheet or resume if needed.
Employer’s name (include self-employment):
Employer’s address:
Dates of employment (M/Y):
Start:
To:
Describe your job duties. Attach additional sheet or resume if needed.
Training
List training course names and dates:
Questions
Do you currently have a New York State Blaster’s Certificate of Competence or Pyrotechnicians Certificate of
Competence?
Yes
No
If yes, certificate number:
Expiration date:
Are you either disloyal or hostile to the United States?
Yes
No
Have you ever been convicted of any crime for which a sentence to serve one year or more was imposed?
Yes
No
Have you ever been confined as a patient or inmate in an institution for the treatment of mental disease?  Yes  No
If you have answered yes to any of the last 3 questions, attach additional sheets with the details.
Certification of Child Support
Are you under an obligation to pay child support? If yes, complete following items.
Yes
No
I am making payments in accordance with a plan agreed upon by the parties.
Yes
No
I am four months or more behind in the payment of child support.
Yes
No
My child support obligation is the subject of a pending court proceeding.
Yes
No
I am receiving public assistance or supplemental security income.
Yes
No
SH 850 (07/19)
Page 2 of 3
Acknowledgement
• I swear the information on this form is correct to the best of my knowledge.
• I am aware there are penalties for making false statements.
• I approve the Department of Labor (DOL) and the Department of Motor Vehicles (DMV) to produce an identification
(ID) card for me using my DMV photo.
o I understand my DMV photo will be used for all future license and certificate ID cards
o I understand that DOL will send this card to the address I maintain with DOL
Applicant’s Signature (no co-signs or rubber stamps):
Date:
Do not write in the area below. For office use only
Date received:
Control #:
Fee:
Full license #:
Expiration date:
SH 850 (07/19)
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