Marquette City Police Department

300 W. Baraga Avenue

Marquette, Michigan 49855-4763

(906) 228-0400

APPLICATION FOR LICENSE TO PURCHASE A PISTOL OR REVOLVER

Name: ___________________________/____________________/______________/____________

(Last) (First) (Middle) (Suf.)

Race: ______________________ Sex: Male £ Female £

Date of Birth:______/____/_____

Address:_______________________________________________________________________

Telephone: _______________________ Social Security # ___________/_____________/_______

Driver's License #: _____________________________

I am a citizen of the United States and have resided in this state for more than six (6) months and have never been adjudged insane or convicted of a felony offense.

Signature:______________________________________________________________________

************************************************************************************************ CRIMINAL RECORD CHECK: Date: _________/__________/________ Local Check: _____________

LEIN Printout # : ___________________ Approved:________ Disapproved:__________

Miscellaneous: _________________________________________________________________________________________________

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