Rockland County, NY · Rockland County
Disclosure Form Arrest/Charge Affidavit
Rockland County pistol permit applicants use this form to disclose arrest and charge history, provide identifying details, and acknowledge the application’s disclosure requirements.
At a glance
- Issued by
- City of Rockland County · Rockland County, Rockland County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- rocklandcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This disclosure form is for pistol permit applicants and asks whether they have ever been arrested, summoned, charged, or indicted, including in situations described on the form. Applicants who have ever been arrested must furnish a certified copy of the disposition or their application will not be processed. The form also requests names, phone numbers, and a signature and date, and says police interactions during the application period must be reported in writing within five business days.
Who needs it
Pistol permit applicants in Rockland County use this form to disclose arrest or charge history and acknowledge the stated reporting requirements.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed and dated without a notary; it does not identify any notarized attachment or separate sworn step.
How to submit this form
- 1
Download the Form
Download the Rockland County Arrest/Charge Disclosure Form.
- 2
Complete the Form
Answer the arrest-history question, provide requested identifying and phone information, and sign and date the form.
- 3
Gather Required Records
If you have ever been arrested, furnish a certified copy of the disposition as the form requires.
- 4
Submit to the County
Submit the completed form to the county department named on it; check the county website for current contact details.
Frequently asked questions
- Do I need a notary for the Arrest/Charge Disclosure Form?
- No. This document is signed and dated without a notary, and it does not identify any notarized attachment or separate sworn step.
- Who uses this disclosure form?
- Rockland County pistol permit applicants use it to report arrest or charge history and acknowledge the form’s disclosure requirements.
- What must I provide if I have ever been arrested?
- The form says you must furnish a certified copy of the disposition or your application will not be processed.
- How do I submit the Arrest/Charge Disclosure Form?
- Submit it to the county department named on the form; check the county website for current contact details.