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Florida Department of Agriculture and Consumer Services Division of Licensing APPLICATION FOR CLASS “G” STATEWIDE FIREARM LICENSE Chapter 493, Florida Statutes Rule 5N-1.100, Florida Administrative Code �������������������������������������������������������������������������������������������������������������������������� www.mylicensesite.com ADAM H. PUTNAM COMMISSIONER FOR DIVISION OF LICENSING USE ONLY TYPE OR PRINT USING BLACK INK PLACE LETTER/NUMBER INSIDE EACH BOX AS SHOWN. BEFORE YOU BEGIN, read the Application Instructions. TYPE or PRINT using black ink. To help avoid unnecessary delay in the processing of your application, be sure to answer all questions and submit any necessary documentation. SECTION I APPLICANT INFORMATION SOCIAL SECURITY NUMBER ALIEN REGISTRATION NUMBER �������������������������������������������� ���������������������� If you are an alien, you must also provide your 8- or 9- digit Alien Registration Number. LAST NAME FIRST NAME MI CITY STATE ZIP CODE +4 - RESIDENCE ADDRESS SEX RACE EYE COLOR HAIR COLOR DATE OF BIRTH (MMDDYYYY) WEIGHT HEIGHT LBS FT IN SEE APPLICATION INSTRUCTIONS A RESIDENCE ADDRESS CONTINUED (SUITE, BUILDING, APT., ETC) CITY STATE ZIP CODE +4 - MAILING ADDRESS IF DIFFERENT FROM ABOVE MAILING ADDRESS CONTINUED (SUITE, BUILDING, APT., ETC) HOME PHONE NUMBER (Numbers only; no dashes or parentheses.) WORK PHONE NUMBER (Numbers only; no dashes or parentheses.) E-MAIL ADDRESS G P D F 0 1 S M I T H 1 2 3 PLACE OF BIRTH (Include STATE OR PROVINCE --- AND COUNTRY)


19859APg
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