Firearms Reference Questionnaire

Complete this form to submit reference information for a firearms applicant.

Firearms Reference – Party Information

Name of Person Submitting the Questionnaire(Required)

First Middle Last Suffix

Phone Number of Person Submitting the Questionnaire(Required)

Email Address of Person Submitting the Questionnaire(Required)

Name of Firearms Applicant Being Investigated(Required)

First Middle Last Suffix

Questions about the Applicant

To your knowledge, has the applicant ever been convicted of a crime or disorderly person’s offense?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

To your knowledge, is the applicant an alcoholic or currently a habitual drunkard?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

To your knowledge, does the applicant use illegal narcotics or is the applicant addicted to prescription medication?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

To your knowledge, does the applicant suffer from any physical defect or illness which would make it unsafe to handle firearms?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

To your knowledge, has the applicant ever been confined to a mental institution or been treated for a mental defect?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

To your knowledge, has the applicant ever been involved in a Domestic incident?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

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?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

Is there any reason you would NOT endorse the above-named firearms applicant to be issued a NJ Firearms Card and/or Permit?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

When you signed the application, were you under any type of coercion or distress?(Required)

If you answered yes to the above question, please provide further explaination.(Required)

How many years have you known the applicant?(Required)

Electronic Signature of Person Completing Questionnaire(Required)

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