Rockland County, NY · Rockland County
Arrest/Charge Disclosure Form
Rockland County pistol permit applicants use this form to disclose arrests, charges, other names, and contact information as part of their application.
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 form is for Rockland County pistol permit applicants and asks whether they have ever been arrested, summoned, charged, or indicted, along with information about any other names they have used and their phone numbers. Applicants who have ever been arrested must provide a certified copy of the disposition. The form also says applicants must report police interactions during the application period in writing within five business days.
Who needs it
Anyone applying for a Rockland County pistol permit must complete this disclosure form and provide the required arrest disposition information if applicable.
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; applicants who have ever been arrested must also provide a certified copy of the disposition.
How to submit this form
- 1
Download the Form
Download the Arrest/Charge Disclosure Form for your Rockland County pistol permit application.
- 2
Complete the Form
Answer the arrest and charge question, select the applicable name statement, and provide your phone numbers.
- 3
Gather Required Records
If you have ever been arrested, provide a certified copy of the disposition.
- 4
Submit to the County
Submit the 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. The form is signed and dated without a notary. Applicants who have ever been arrested must provide a certified copy of the disposition.
- Who completes this disclosure form?
- The form is addressed to all Rockland County pistol permit applicants and asks about arrests, charges, other names, and phone numbers.
- What should I provide if I have ever been arrested?
- The form says you must provide 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.