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Firearms Reference Form

  1. It is necessary that we conduct an investigation to insure that only the applications of persons qualified by law are approved.  Your cooperation in truthfully answering and completing this questionnaire is necessary to help us make this determination.

  2. As the person completing this reference questionnaire, please provide YOUR information in this section.

    DO NOT ENTER THE APPLICANT NAME IN THIS SECTION.

  3. Please provide information about the APPLICANT in this section.

    DO NOT ENTER YOUR NAME IN THE APPLICANT NAME FIELD.

  4. To your knowledge, has the applicant ever been convicted of a crime or disorderly person’s offense?*
  5. To your knowledge, is the applicant an alcoholic or currently a habitual drunkard?*
  6. To your knowledge, does the applicant use illegal narcotics or is the applicant addicted to prescription medication?*
  7. To your knowledge, does the applicant suffer from any physical defect or illness which would make it unsafe to handle firearms?*
  8. To your knowledge, has the applicant ever been confined to a mental institution or been treated for a mental defect?*
  9. To your knowledge, does the applicant suffer from any mental condition which would make it unsafe to handle firearms?*
  10. To your knowledge, has the applicant ever been involved in a Domestic incident?*
  11. To your knowledge, has the applicant ever been a member of any organization which advocates the overthrow of the U.S. Government or the State of New Jersey?*
  12. Is there any reason you would NOT endorse the above named applicant to be issued a concealed carry permit for a handgun?*
  13. I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this reference void. Furthermore, I affirm that I am indeed the named individual listed above and that I am submitting this reference on my own behalf.*
  14. Leave This Blank:

  15. This field is not part of the form submission.