(Face of application form)
Application to Purchase Pistol or Revolver
Date . . . . . Hour . . . . . A.M. P.M. |
Name . . . .. |
Address . . . .. |
(Street and number) (City or town) (State) |
Date of Birth . . . . . Place of Birth . . . .. |
Height . . . . . Weight . . . . . Color hair . . . . . |
Color eyes . . . .. |
Scars . . . .. |
Tattoos . . . .. |
Other identifying marks . . . .. |
Are you a citizen of the United States . . . .. |
Are you a citizen of Rhode Island . . . .. |
How long . . . .. |
Where stationed . . . .. |
(Armed Forces only) |
Number of pistols and/or revolvers to be purchased . . . .. |
Have you ever been convicted of a crime of violence . . . .. |
(See § 11-47-2) |
Have you ever been adjudicated or under confinement as addicted to a controlled substance . . . .. |
Have you ever been adjudicated or under confinement for alcoholism . . . .. |
Have you ever been confined or treated for mental illness . . . .. |
From whom is pistol or revolver being purchased . . . . . |
Seller's address . . . .. |
Seller's signature . . . .. |
Applicant's signature . . . .. |
(See § 11-47-23 for penalty for false information on this application) |
(Reverse side of application form)
AFFIDAVIT: I certify that I have read and am familiar with the provisions of §§ 11-47-1 - 11-47-55, inclusive, of the general laws of the State of Rhode Island, and that I am aware of the penalties for violation of the provisions of the cited sections. I further certify that I have completed the required basic pistol/revolver safety course. |
Signed . . . .. |
(over) |
County of . . . .. |
State of Rhode Island |
Subscribed and sworn before me this ..... day of ...... A.D. 20.... |
Notary Public |
.............................. |
R.I. Gen. Laws § 11-47-35