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) |