Woodbury, CT - PISTOL PERMIT APPLICATIONS

_____________________________________________________________________

INSTRUCTIONS FOR A PISTOL PERMIT APPLICATIONS

• Applications must be signed in the presence of a Notary Public

• Sign both Privacy Notices

• ALL paperwork to be returned to the Woodbury Police Department

• You must be over 21 years of age

• You will also need to present the original of the following:

o Valid US Passport or Birth Certificate

o Valid CT Driver’s License or Photo ID

o If discharged from the Military, your DD214 papers

o Original Firearms Training Course Certificate

• As part of your background check, the First Selectman, or his/her designee, may notify

you of the need for a personal interview.

• Fingerprints to be taken @ CT State Police Barracks, Troop L in Litchfield.

o Payments will be made directly to the State of Connecticut at the following

website: https://ct.flexcheck.us.idemia.io/cchrspreenroll *Note: A service code

will be needed to log in to this payment system – it will be provided to you by the

Police department when all your paperwork is turned in.

o A barcode receipt will be needed to be turned in when you are fingerprinted

• You will be contacted via a phone call when your permit is ready to be picked up at the

Police Office.

• The temporary permit fee is $70.00 – payable by check, “Town of Woodbury” at the time

the permit is issued.

• Temporary Permit is VALID FOR 60 DAYS

• Once the temporary permit has been issued by the town, the applicant must apply

within 60 days for a state permit. See attached locations

If you have any questions, please contact the Woodbury Police Department – 203.263.3400

Town of Woodbury

281 Main Street South

P.O. Box 369

Woodbury, Connecticut 06798

STATE OF CONNECTICUT

DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICE

DPS-799-C (Rev. 03/03/21) An Affirmative Action/Equal Employment Opportunity Employer Page 1 of 4

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 State Pistol Permits:

Instructions for Non-Resident

State Pistol Permits:

Instructions for Eligibility

Certificates to Purchase Pistols

or Revolvers and/or Eligibility

Certificates to Purchase Long

Guns:

1. Complete this form (DPS-799-C) and submit to

appropriate local authority (local police, resident

state trooper or first select person, as applicable)

along with all of the following:

 Firearms Safety & Use Course Certificate;

 $70.00, fee, payable to the local authority;

and

 Proof you are legally and lawfully in the

United States (e.g., certified copy of birth

certificate, U.S. passport or documentation

issued by I.C.E.).

2. Submit fingerprints for a criminal history check

through a law enforcement agency. Fees include

a $75.00 fee and a $13.25 fee, payable at the

agency where the prints are taken. Fees must be

paid by separate checks.

3. Upon approval, the local authority will issue a

Temporary State Permit to Carry Pistols and

Revolvers (DPS-11-C), effective for 60 days.

4. Within the 60 day period, go to a DESPP,

Division of State Police, pistol permit location and

submit the following:

 The Temporary State Permit to Carry Pistols

and Revolvers (DPS-11-C) issued by the

local authority;

 A completed Application for State Permit to

Carry Pistols and Revolvers (DPS-46-C);

 $70.00 fee, payable to Treasurer, State of

Connecticut;

 Proof you are legally and lawfully in the

United States (e.g., certified copy of birth

certificate, U.S. passport or documentation

issued by I.C.E.); and

 Proof of valid state issued photo identification

card.

5. Upon approval, your photograph will be taken at

DESPP and you will be issued a state pistol permit.

**CALL DESPP FOR PACKET**

You must hold a valid permit or

license to carry a pistol or revolver

issued by a recognized United States

jurisdiction.

Complete this form and submit to

DESPP, Division of State Police, pistol

permit location along with all of the

following:

 Completed State of CT and Federal

fingerprint card with $75.00 fee and

$13.25 fee, payable to Treasurer,

State of Connecticut for criminal

history background checks;

 Firearms Safety & Use Course

Certificate;

 $70.00 fee, payable to Treasurer,

State of Connecticut;

 Completed Application for State

Permit to Carry Pistols and Revolvers

form (DPS-46-C);

 Completed DPS-129-C signed and

notarized and 2x2 color photograph

(passport style);

 Copy of the permit or license to carry

a pistol or revolver issued to you by a

recognized United States jurisdiction;

 Proof you are legally and lawfully in

the United States (e.g., certified copy

of birth certificate, U.S. passport or

documentation issued by I.C.E.);and

 Proof of valid state issued photo

identification card.

Out of State Pistol Permit Information:

State of Issue: _______________

Expiration Date: _____________

Permit Number: ______________

1. Complete this form and submit in

person at DESPP Headquarters,

Division of State Police, located at

1111 Country Club Road,

Middletown, Connecticut along with

the below:

 Firearms Safety & Use Course

Certificate;

 $35.00 fee, payable to

Treasurer, State of

Connecticut;

 Application for a State Eligibility

Certificate for a Pistol or

Revolver or for Long Guns

(DPS-164-C);

 Proof you are legally and

lawfully in the United States

(e.g., certified copy of birth

certificate, U.S. passport or

documentation issued by

I.C.E.); and

 Proof of valid state issued photo

identification card.

2. Submit fingerprints for a criminal

history check through a law

enforcement agency. Fees include a

$75.00 fee and a $13.25 fee, payable

at the agency where the prints are

taken. Fees must be paid by separate

checks.

3. Upon approval, your photograph will

be taken at DESPP and you will be

issued an eligibility certificate.

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.

STATE OF CONNECTICUT

DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICE

DPS-799-C (Rev. 03/03/21) An Affirmative Action/Equal Employment Opportunity Employer Page 2 of 4

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

/ /

Month/Day/Year

Sex

F M X

Height

Ft. In.

Weight

Lbs.

Eye Color

Brown Blue Black

Green Gray Hazel

Race

White American Indian/Alaskan Native Asian/Pacific Islander

Black Unknown Other

Hair Color

Brown Black Blonde Red

Gray White Bald

Place of Birth

,

City/Town State

Social Security Number (Optional, but will help

prevent misidentification)

- -

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

Home Telephone Number

( ) -

Area Code

Alternate Telephone Number

( ) -

Area Code

Motor Vehicle Operator’s License Number

State of Issue

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:______________________________________

STATE OF CONNECTICUT

DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICE

DPS-799-C (Rev. 03/03/21) An Affirmative Action/Equal Employment Opportunity Employer Page 3 of 4

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?

NO YES If "YES,” list all convictions, include charges, location, date of arrest, and disposition. (Attach additional

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

STATE OF CONNECTICUT

DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICE

DPS-799-C (Rev. 03/03/21) An Affirmative Action/Equal Employment Opportunity Employer Page 4 of 4

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 C.G.S. § 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

Board of Firearms Permit Examiners, at 165 Capitol Ave., Suite 1070, Hartford, CT 06106. Telephone: (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:

/ /

Month/Day/Year

FBI Sent: No Yes

FBI Reply: No Yes

ICE Response: No Yes

DMHAS: No Yes

SPBI: No Yes

Number :

Application Status:

Approved Denied

(Signature and title of issuing authority)

Connecticut State Pistol Permit Locations

DESPP

1111 Country Club Road

Middletown, CT

M-F 8:30 am – 4:45 pm

Troop G

149 Prospect Street

Bridgeport, CT

Tues, Wed, Fri, Sat – 8 am – 12 noon and 12:30 pm – 3:45 pm

Troop E

I-395 North, between exits 79 & 79A

Montville, CT

Thu 11 am – 2 pm and 2:30 pm – 6:45 pm

Bring with you the following paperwork:

• Temporary state permit

• Birth certificate or Passport

• Photo Id – driver’s license

• Check in the amount of $70.00 – made payable to “Treasurer – State of CT”

You will be required to fill out additional forms and your picture will be taken for your

permanent State Permit.