Essex County. 2 documents captured.
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LYNN POLICE DEPARTMENT
LTC – FID APPLICATION
OFFICE USE ONLY
NEW RENEWED REPLACED
INS # LIC # PERMIT #
BC-PP ENTERED IN COMP.
DL DMH
BIL
COMP STATE POLICE
APPLICANT’S EMAIL ADDRESS:
Last Name First Name M.
CIRCLE ONE
YES NO Are you now or have you ever been a defendant in a Domestic Abuse Prevention Case (G.L. 209A)?
If yes, please specify below.
YES NO Have you ever been criminally charged with an offense involving Domestic Abuse?
If yes, please specify below.
NOTICE False Statements or Failure to disclose information in any Domestic Abuse Prevention Case will be grounds to designate
the Applicant as an “UNSUITABLE PERSON”, which pursuant to (G.L. Ch. 140 Section 131) will be grounds for
Denial-Revocation of any or all Permits or License.
X Applicant’s Signature DATE
DO NOT FILL IN THIS SECTION UNTIL REQUESTED TO DO SO
I AUTHORIZE The Lynn Police Department to review any records from the Lynn District Court Clinic or any Mental Health Facility
to determine whether there is any history of mental illness. This release is valid for 30 days from date below.
X Signature DATE Witness
1. $100.00 check or money order, made payable to “City of Lynn” Non-Refundable Application Fee for LTC or FID. There is NO FEE for
Applicants 70 years or older who are renewing their LTC or FID.
2. All applicants must be a resident of Lynn and be at least 21 years of age.
3. New and Renewals Applicants must have:
a. If born in the United States, a Birth Certificate or U.S. Passport
b. If not born in the United States, a Certificate of Naturalization, Permanent Resident Card, or U.S. Passport.
• Photo copies of all documents ARE accepted.
4. MA Driver’s License or MA ID
5. Two current bills of different companies (i.e. – utility, medical, dental, credit card) (within three (3) months) that show proof of residency –
must have FULL NAME and ADDRESS.
6. New Applicants for LTC/FID must bring their original certificate of competency course given by a State Certified Instructor.
H:\APP'S FOR WEBSITE\LTC\Police - Gun Permit - FID Application 24APR2023.docPolice Department/Police – Gun Permit – FID
Application.doc
THE COMMONWEALTH OF MASSACHUSETTS PD USE ONLY
EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY FTN: _______________
Department of Criminal Justice Information Services
200 Arlington Street, Suite 2200, Chelsea, MA 02150 LIC #: _______________
mass.gov/cjis | TTY: 617-660-4606
You must submit this form to your local police department
MASSACHUSETTS RESIDENT LTC/FID/MACHINE GUN APPLICATION
FOR NEW/RENEWAL OF A FIREARMS IDENTIFICATION CARD OR LICENSE TO CARRY
FIREARMS OR LICENSE TO POSSES A MACHINE GUN (M.G.L c. 140, §§ 129B, 131)
CHECK ONE:
New Applicant*
Renewal - Most Recent License to Carry/FID Number:
*NOTE: If application is for a first firearms identification card or license to carry firearms, a copy of the Firearms Safety Certificate or
Hunter Safety Course Certificate must be attached, unless exempt by statute. If this is a renewal application, a lost/stolen firearms
affidavit must be submitted.
LICENSE APPLICATION TYPE (Check Only One):
Firearms Identification Card - Restricted (self-defense spray)
Firearms Identification Card
License to Carry
License to Possess a Machine Gun
Gun Club License (Only the Colonel of the State Police can issue a club license)
EXCEPT FOR SIGNATURE, PRINT OR TYPE ALL REQUESTED INFORMATION:
Last Name First Name Middle Name Suffix
Residential Address City State Zip Code Telephone Number
Mailing Address City State Zip Code Telephone Number
Date of Birth Place of Birth (City, State, Country)
Mother's First Name Mother's Maiden Name Father's First Name Father's Last Name
Height Weight Build Complexion Hair Color Eye Color
Occupation Social Security Number (Optional) Drivers License Number
Employed By Business Address
City/Town State Zip Telephone Number
LTC-FID Application – Revised May 2015 Page - 1 of 4
ANSWER THE FOLLOWING QUESTIONS COMPLETELY AND ACCURATELY:
1. Are you a citizen of the United States? YES NO
If lawful permanent resident alien, give
green card number and resident date Green Card Number Resident Since (date)
If naturalized, give date, place
and naturalization number Date Place Naturalization No.
2. Have you ever renounced your U.S. citizenship? YES NO
3. What is your age? ________ (You must be 21 to apply for a LTC, 18 to apply for a FID card, or 14 to 17 with
4. submission of a certificate of parent or guardian granting permission to apply for a FID card or FID card – Restricted).
5. Have you ever been arrested or appeared in court as a defendant for any criminal offense? YES NO
6. Are you the subject of any pending criminal charges? YES NO
7. Have you ever been convicted of a felony? YES NO
8. Have you ever been convicted of the unlawful use, possession, or sale of controlled substances
as defined in M.G.L. c. 94C, § 1? YES NO
9. Have you ever been convicted of a violent crime or a crime of domestic violence? YES NO
10. Have you ever been convicted as an adult or adjudicated a youthful offender or delinquent child
in any state or federal jurisdiction? YES NO
11. Are you now, or have you ever been the subject of a restraining order issued pursuant to M.G.L. c. 209A,
or a similar order issued by another jurisdiction? YES NO
12. Are you currently the subject of any outstanding arrest warrant in any state or federal jurisdiction? YES NO
13. Have you ever been committed to any hospital or institution for mental illness, or alcohol or substance abuse? YES NO
13. Has any firearms license issued under the laws of any state or territory ever been suspended, revoked,
or denied? YES NO
14. Have you been discharged from the armed forces of the United States under dishonorable conditions? YES NO
15. Have you been the subject of an order of the probate court appointing a guardian or conservator? YES NO
If you answered "YES" to any of the questions 2-15, give details which must include dates,
circumstances and location; use a separate sheet of paper if necessary.
LTC-FID Application – Revised May 2015 Page - 2 of 4
Have you ever used or been known by another name? YES NO
If “YES”, provide name and explain:
Other than Massachusetts, in what state(s), territory(ies), or jurisdiction(s) have you lived? NONE
Have you ever held a firearms license in any other state, territory or jurisdiction? YES NO
If "YES", when, where, and license number?
List the name and addresses of two references (as required by your licensing authority)
Last Name First Name
Address City/Town State Zip
Last Name First Name
Address City/Town State Zip
Reason(s) for requesting the issuance of a card or license:
Target & Hunting Sporting Employment Unrestricted (use lines below to indicate the reason(s) you are
requesting an unrestricted LTC; use a separate sheet of paper if
necessary)
WARNING Any person who knowingly files an application containing false information shall be punished by a fine of not less than
$500 nor more than $1,000 or by imprisonment for not less than 6 months nor more than 2 years in a house of correction, or by both
such fine and imprisonment (M.G.L c.140, §§ 129B(8), 131(h)).
I declare the above facts are true and complete to the best of my knowledge and belief and I understand that any false answer(s)
will be just cause for denial or revocation of my license to carry firearms. I understand that filing an application that contains false
information is a criminal offense.
Signed under the penalties of perjury this day of
day month year
Signature of Applicant:
LTC-FID Application – Revised May 2015 Page - 3 of 4
Massachusetts License to Carry (LTC)/Firearms Identification Card (FID) Affidavit
Complete this form only if you are renewing your firearms license.
License Holder Name: ________________________________________________
Current LTC or FID card Number: ________________________________________________
Please select one:
A. (No firearm(s) lost or stolen since previous issuance of LTC or FID card)
1. I am renewing a Massachusetts firearms identification (FID) card or license to carry
(LTC) firearms.
2. I have not lost one or more firearms or had any firearms stolen since the renewal or
issuance of my last FID card or LTC.
B. (Firearm(s) reported lost or stolen since previous issuance of LTC or FID card)
1. I am renewing a Massachusetts firearms identification (FID) card or license to carry
(LTC) firearms.
2. I have lost one or more firearms or have reported stolen one or more firearms since
the renewal or issuance of my last FID card or LTC.
List all lost or stolen firearms below; use additional sheets as necessary.
Lost or Date Reported Reported to Type Make Model Serial Number Case Number
Stolen Lost or Stolen (Police Dept.)
The above information is true and accurate to the best of my knowledge and belief.
SIGNED UNDER THE PENALTIES OF PERJURY:
Signature:____________________________________ Date:_________________________
LTC-FID Application – Revised May 2015 Page - 4 of 4
The provisions a municipal licensing page most often touches: G.L. c. 140, § 131 (licenses to carry), G.L. c. 140, § 121F (applications, suitability, judicial review), G.L. c. 140, § 131P (the safety certificate).