Permit to Purchase - Duplin County

2. is an official representative of a foreign government who is accredited to the United States Government or his or hergovernment's mission to an International organization having its headquarters in the United States, or3. has received a waiver from the prohibition from the Attorney General of the United States.See 18USC922 (y) (2) for additional exceptions. In order to determine whether applicants who are not US citizens areprohibited from possessing firearms under Federal Law, it is necessary to obtain answers to the following questions:Are you a citizen of the United States? (if ''Yes", skip to ♦)What is your country of citizenship?What is your birthplace?What is your INS # (issued alien number or admission number)?Are you an alien illegally In the United States?Are you a non-immigrant alien?Do you fall within any of the exemptions to non-immigrant alien prohibitions set forth in 18USC922(y) ?if yes, under which exemption do you fall?PLEASE ATTACH DOCUMENTATION TO SUPPORT YOUR ENTITLEMENT TO THE ABOVE CLAIMED EXEMPTION.♦ Character References -No Relatives ♦Name:Name reference knows you by:Address:Home phone:Cell phone:Race:Sex:Occupation:Employer:Work phone:How long has this reference known you?Name:Name reference knows you by:Address:Home phone:Cell phone:Race:Sex:Occupation:Employer:Work phone:How long has this reference known you?

Name:Name reference knows you by:Address:Home phone:Cell phone:Race:Sex:Occupation:Employer:Work phone:How long has this reference known you?***************************************************************************************************************************************************I DO HEREBY CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IALSO UNDERSTAND THAT ANY FALSIFICATION OF THE ABOVE INFORMATION WILL RESULT IN THE REFUSAL OF MYAPPLICATION FOR A PISTOL PERMIT.THIS APPLICATION WILL EXPIRE IN 30 DAYS.(Signature of Applicant)(Date)