CLEAR FORM

STATE OF NEW JERSEY

Application for Permit to Carry a Handgun
Application must be delivered, in triplicate, to the Chief of Police of the municipality wherein you reside, or to the
Superintendent of State Police in all other cases. A money order in the amount of $50.00 payable to the State of New
Jersey—Treasurer must accompany this application.
Answer all questions. If more space is needed, attach bond paper. Page two must be completed. Four photographs of the applicant, one and one-half inch square,
head and shoulders, no hat, light background, taken within the last 30 days must accompany this application.
This form is prescribed by the Superintendent for use by applicants for a Municipal Code
Permit to Carry a Handgun. Any alteration to this form is expressly forbidden.  NEW  RENEWAL
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S.P. 642 (Rev. 07/22)
635HY 3DJH2QHRI7ZR3DJHV <HV/LVWRQ3DJH1R

NOTICE: If Internet form, print Page 1, return to printer and print Page 2 on reverse side.
Endorsement Number One — Reference must have known applicant for a minimum of three years preceding the date of the application.

I am personally acquainted with , the applicant named on page one of this application. I have known Him/Her for
Name of applicant from page one
the past years to be a person of good moral character and behavior and who is capable of exercising self control. I have reviewed this application

and I believe that the answers given by the applicant to the questions set forth in this application are complete, true and correct in every particular.

Print or Type Name No. Street Address

Signature City/Town State Zip

Date of Endorsement Home Telephone Number Business Telephone Number

Endorsement Number Two — Reference must have known applicant for a minimum of three years preceding the date of the application.

I am personally acquainted with , the applicant named on page one of this application. I have known Him/Her for
Name of applicant from page one
the past years to be a person of good moral character and behavior and who is capable of exercising self control. I have reviewed this application

and I believe that the answers given by the applicant to the questions set forth in this application are complete, true and correct in every particular.

Print or Type Name No. Street Address

Signature City/Town State Zip

Date of Endorsement Home Telephone Number Business Telephone Number

Endorsement Number Three — Reference must have known applicant for a minimum of three years preceding the date of the application.

I am personally acquainted with , the applicant named on page one of this application. I have known Him/Her for
Name of applicant from page one
the past years to be a person of good moral character and behavior and who is capable of exercising self control. I have reviewed this application

and I believe that the answers given by the applicant to the questions set forth in this application are complete, true and correct in every particular.

Print or Type Name No. Street Address

Signature City/Town State Zip

Date of Endorsement Home Telephone Number Business Telephone Number

State of New Jersey

SS
County of

being duly sworn, upon oath deposes and states that he/she is the applicant named on page one
Name of Applicant from page one
of this application; that the answers to the questions given on this application are complete, true and correct in every particular.
This Day of , 20
Signature of Applicant named on page one Date of Application
(The disclosure of my social security number is voluntary. Without this number, the processing
of my application may be delayed. This number is considered confidential.) I realize that if any
of the foregoing answers made by me are false, I am subject to punishment.
Notary Public Falsification of this form is a crime of the third degree as provided in NJS 2C:39-10c.

SPACE BELOW RESERVED FOR SUPERIOR COURT JUDGE GRANTING PERMIT

List Permit Restrictions Here:
Photograph of
Applicant
1.5 x 1.5 inches

S.P. 642 (Rev. 06/22) Page 2