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
NICOLE “NIKKI” FRIED
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)
/www.mylicensesite.com