Free Firearms Identification Card (FID) or License to Carry (LTC) Application (New and Renewal) - Massachusetts

APPLICATION FOR NEW/RENEWAL OF A FIREARMS IDENTIFICATION CARD (FID) OR LICENSE TO CARRY FIREARMS OR LICENSE TO POSSESS A MACHINE GUN
************************************ POLICE DEPARTMENT USE ONLY ************************************
IT IS THE RESPONSIBILITY OF THE LICENSING AUTHORITY TO ENSURE THE IDENTITY OF THE NEW/RENEWAL APPLICANT IS TRUE AND ACCURATE, AND IN THE CASE OF A RENEWAL, THAT THE APPLICANT IS LINKED TO THE ORIGINAL TRACKING NUMBER.

IF RENEWAL ORIGINAL TRACKING NUMBER 1

NEW LTC OR FID NUMBER

F (__ __ __) __ __ __ __ __ __ __ __ __
City/Town
1

(__ __ __) __ __ __ __ __ __ __ __ __
City/Town 9 Digit License Number

9 Digit License Number

THE ORIGINAL TRACKING NUMBER IS OBTAINED FROM THE FIRST ISSUED LTC/FID ISSUED UNDER THE GUN CONTROL ACT OF 1998, WHICH WENT INTO EFFECT ON OCTOBER 21, 1998. ******************************************************************************************************
PLEASE COMPLETE THIS APPLICATION FORM AND TAKE IT TO YOUR LOCAL LICENSING AUTHORITY. (LOCAL POLICE DEPARTMENT). DO NOT MAIL TO THE FIREARMS RECORD BUREAU.

PLEASE CHECK ONE: [ ] NEW APPLICANT [ ] RENEWAL ­ MOST RECENT LICENSE TO CARRY/FID CARD NUMBER ___________________ ISSUED FROM WHICH CITY/TOWN?___________________________, MA EXPIRATION DATE _________________
CHECK THE TYPE OF LICENSE YOU ARE APPLYING FOR: [ ] FIREARMS IDENTIFICATION CARD RESTRICTED (MACE/PEPPER SPRAY) [ ] FIREARMS IDENTIFICATION CARD [ ] CLASS B LICENSE TO CARRY FIREARMS NON-LARGE CAPACITY [ ] CLASS A LICENSE TO CARRY FIREARMS LARGE CAPACITY [ ] LICENSE TO POSSESS A MACHINE GUN 1. 2. [ ] CHECK IF CLASS A CLUB LICENSE *
* NOTE: ONLY THE COLONEL OF THE MASSACHUSETTS STATE POLICE CAN ISSUE A CLUB LICENSE.

TWO PHOTOGRAPHS ARE REQUIRED FOR LICENSING. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR LOCAL POLICE DEPARTMENT. IF APPLICATION IS FOR FIRST FID OR LTC, A COPY OF THE FIREARMS SAFETY CERTIFICATE OR HUNTER SAFETY COURSE CERTIFICATE MUST BE ATTACHED TO THIS APPLICATION. IF ISSUED FOR EMPLOYMENT PURPOSES A LETTER FROM EMPLOYER ON COMPANY LETTERHEAD REQUESTING ISSUANCE AND REASON MUST ACCOMPANY THIS APPLICATION.

3.

(EXCEPT FOR SIGNATURE, PRINT OR TYPE ALL REQUESTED INFORMATION)
CITY/TOWN OF: __________________________________ , MA / LAST NAME FIRST NAME /( RESIDENTIAL ADDRESS (Include Number, Street, City/Town, Zip Code) /( IF CLUB LICENSE ADDRESS OF CLUB (Include Number, Street, City/Town, Zip Code) / DATE OF BIRTH FT HEIGHT IN PLACE OF BIRTH / WEIGHT / BUILD / MOTHER'S MAIDEN NAME / COMPLEXION / OCCUPATION / EMPLOYED BY (SEE # 3 ABOVE) ADDRESS S. S. NUMBER (Optional) / HAIR COLOR / DRIVER'S LICENSE NUMBER /( ) TELEPHONE NUMBER / FATHER'S FULL NAME / EYE COLOR / MIDDLE NAME ) TELEPHONE NUMBER ) TELEPHONE NUMBER

F 25/26 01/04/02

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*WARNING*

ANY PERSON WHO KNOWINGLY FILES AN APPLICATION CONTAINING FALSE INFORMATION SHALL BE PUNISHED BY A FINE OF NOT LESS THAN $500 NOR MORE THAN $1,000 OR BY IMPRISONMENT FOR NOT LESS THAN 6 MONTHS NOR MORE THAN 2 YEARS IN A HOUSE OF CORRECTION, OR BY BOTH SUCH FINE AND IMPRISONMENT (M.G.L. c.140, § 131).

PLEASE ANSWER THE FOLLOWING QUESTIONS COMPLETELY AND ACCURATELY: SPACE FOR EXPLANATION AND DETAILS ARE PROVIDED ON PAGE 3. 1. ARE YOU A CITIZEN OF THE UNITED STATES? ___________. IF NATURALIZED GIVE DATE, PLACE AND NATURALIZATION NUMBER:_____________________________. 2. HAVE YOU EVER USED OR BEEN KNOWN BY ANOTHER NAME? ___________. IF YES PROVIDE NAME AND EXPLAIN:___________________________________________________________________________________________ WHAT IS YOUR AGE?* ____________ *YOU MUST BE 21 YEARS OF AGE TO APPLY FOR A LICENSE TO CARRY FIREARMS, 18 YEARS OF AGE* TO APPLY FOR A FIREARMS IDENTIFICATION CARD. * 15 YEARS OF AGE BUT LESS THAN 18 YEARS OF AGE WITH SUBMISSION OF A CERTIFICATE FROM PARENT OR GUARDIAN GRANTING PERMISSION TO APPLY FOR A FIREARMS IDENTIFICATION CARD. HAVE YOU EVER BEEN CONVICTED OF A FELONY? __________ HAVE YOU EVER BEEN CONVICTED OF THE UNLAWFUL USE, POSSESSION, OR SALE OF NARCOTIC OR HARMFUL DRUGS AS DEFINED IN M.G.L. c. 94C, § 1? __________ HAVE YOU EVER BEEN CONVICTED OF A CRIME PUNISHABLE BY INCARCERATION BY MORE THAN (1) ONE YEAR? ___________ IN ANY STATE OR FEDERAL JURISDICTION HAVE YOU EVER BEEN CONVICTED AS AN ADULT OR ADJUDICATED A YOUTHFUL OFFENDER OR DELINQUENT CHILD FOR THE COMMISSION OF (a) A FELONY; (b) A MISDEMEANOR PUNISHABLE BY IMPRISONMENT FOR MORE THAN 2 YEARS; (c) A VIOLENT CRIME AS DEFINED IN M.G.L. c. 140, § 121; (d) A VIOLATION OF ANY LAW REGULATING THE USE, POSSESSION, OWNERSHIP, SALE, TRANSFER, RENTAL, RECEIPT OR TRANSPORTATION OF WEAPONS OR AMMUNITION FOR WHICH A TERM OF IMPRISONMENT MAY BE IMPOSED; OR (e) A VIOLATION OF ANY LAW REGULATING THE USE, POSSESSION OR SALE OF CONTROLLED SUBSTANCES AS DEFINED IN M.G.L. c. 94, § 1? __________ HAVE YOU EVER BEEN CONFINED TO ANY HOSPITAL OR INSTITUTION FOR MENTAL ILLNESS? ________ ARE YOU OR HAVE YOU EVER BEEN UNDER TREATMENT FOR OR CONFINEMENT FOR DRUG ADDICTION OR HABITUAL DRUNKENNESS? __________

3.

4. 5.

6.

7.

8. 9.

10. HAVE YOU EVER APPEARED IN ANY COURT AS A DEFENDANT FOR ANY CRIMINAL OFFENSE (EXCLUDING NONCRIMINAL TRAFFIC OFFENSES)? __________ 11. ARE YOU NOW UNDER ANY CHARGE(S) FOR ANY OFFENSE(S) AGAINST THE LAW? __________ 12. ARE YOU NOW OR HAVE YOU EVER BEEN THE SUBJECT OF A M.G.L. c. 209A RESTRAINING ORDER OR INVOLVED IN A DOMESTIC VIOLENCE CHARGE? __________ 13. HAS ANY LICENSE TO CARRY FIREARMS, PERMIT TO POSSESS FIREARMS, OR FIREARMS IDENTIFICATION CARD ISSUED TO YOU UNDER THE LAWS OF ANY STATE, TERRITORY OR JURISDICTION EVER BEEN SUSPENDED, REVOKED OR DENIED? __________ 14. ARE YOU CURRENTLY THE SUBJECT OF ANY OUTSTANDING ARREST WARRANT IN ANY STATE OR FEDERAL JURISDICTION? __________

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NAME __________________________________ DOB: _____________ IF YOU ANSWERED "YES" TO ANY OF THE QUESTIONS FOUR THROUGH FOURTEEN, GIVE DETAILS WHICH MUST INCLUDE DATES, CIRCUMSTANCES AND LOCATION: ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ (IF NECESSARY USE SEPARATE SHEET OF PAPER TO COMPLETE) OTHER THAN MASSACHUSETTS, WHAT OTHER STATE, TERRITORY OR JURISDICTION HAVE YOU RESIDED IN? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ HAVE YOU EVER HELD A LICENSE TO CARRY IN ANY OTHER STATE, TERRITORY OR JURISDICTION? __________ IF "YES", WHEN, WHERE AND LICENSE NUMBER: ______________________________________________________________________________________________________ LIST NAME AND ADDRESSES OF TWO REFERENCES (NOT REQUIRED IF APPLYING FOR A FIREARMS IDENTIFICATION CARD): 1._____________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2._____________________________________________________________________________________________________ ______________________________________________________________________________________________________

REASON (S) FOR REQUESTING THE ISSUANCE OF CARD OR LlCENSE: ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ _____

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CHANGE OF ADDRESS NOTIFICATION REQUIREMENTS: MASSACHUSETTS GENERAL LAW REQUIRES THAT: ANY LICENSEE SHALL NOTIFY, IN WRITING, THE LICENSING AUTHORITY WHO ISSUED SAID LICENSE, THE CHIEF OF POLICE INTO WHOSE JURISDICTION THE LICENSEE MOVES AND THE EXECUTIVE DIRECTOR OF THE CRIMINAL HISTORY SYSTEMS BOARD OF ANY CHANGE OF ADDRESS. SUCH NOTIFICATION SHALL BE MADE BY CERTIFIED MAIL WITHIN 30 DAYS OF ITS OCCURRENCE. FAILURE TO SO NOTIFY SHALL BE CAUSE FOR REVOCATION OR SUSPENSION OF SAID LICENSE (M.G.L. c.140, § 131 (l). A CARDHOLDER SHALL NOTIFY, IN WRITING, THE LICENSING AUTHORITY THAT ISSUED SUCH CARD, THE CHIEF OF POLICE INTO WHOSE JURISDICTION SUCH CARDHOLDER MOVES AND THE EXECUTIVE DIRECTOR OF THE CRIMINAL HISTORY SYSTEMS BOARD OF ANY CHANGE OF ADDRESS. SUCH NOTIFICATION SHALL BE MADE BY CERTIFIED MAIL WITHIN 30 DAYS OF ITS OCCURRENCE. FAILURE TO SO NOTIFY SHALL BE CAUSE FOR REVOCATION OR SUSPENSION OF SUCH CARD (M.G.L. c.140, § 129B (11).

I DECLARE THE ABOVE FACTS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND I UNDERSTAND THAT ANY FALSE ANSWER(S) WILL BE JUST CAUSE FOR DENIAL OR REVOCATION OF MY LICENSE TO CARRY FIREARMS AND MAY BE USED IN A CRIMINAL PROCEEDING PURSUANT TO M.G.L c. 140, §§ 129 AND 131.
SIGNED UNDER THE PENALTIES OF PERJURY THIS _____ DAY OF _________________, __________
(DAY) (MONTH) (YEAR)

SIGNATURE OF APPLICANT __________________________________________________

APPLICANT: BRING TO YOUR LOCAL LICENSING AUTHORITY (POLICE D EPARTMENT). DO NOT MAIL THE FIREARMS RECORD BUREAU.

LICENSING AUTHORITY (LOCAL POLICE DEPARTMENT: PLEASE RETAIN ONE COPY FOR YOUR FILES, FORWARD ONE COPY TO THE FIREARMS RECORD BUREAU WITH THE COMPLETED LTC/FID OR MG LICENSE FOR DATA ENTRY AND ONE COPY TO THE MASS STATE POLICE WITH THE APPLICANT'S FINGERPRINT CARD (FINGERPRINT CARD REQUIRED FOR NEW APPLICANT, ONLY) FOR APPROPRIATE FINGERPRINT SUPPORTED CRIMINAL RECORD CHECK.