Get CT DPS-129-C 2011-2024

STATE OF CONNECTICUT Department of Emergency Services and Public Protection 1111 Country Club Road Middletown CT 06457-2389 DPS-129-C 08/31/11 FORM MUST BE ACCOMPANIED BY Name Address City State Zip Place of Birth Country of Citizenship Telephone Proof of legal and lawful presence in the United States Copy of U.S. Passport Birth Certificate or U.S. Citizenship and Immigration Services issued permanent residence identification/documentation. 70. 00 Fee Check or money order payable to Treasurer State of Connecticut. DO NOT SEND CASH. Copy of valid photo identification if providing a birth certificate as proof of legal and lawful presence in the United States. Notarization ONLY if renewing by mail* Alien Registration Number if applicable Date of Expiration if AR has exp date FOLD HERE Please check the information below PERMIT ID NUMBER ATTACH IN THIS SQUARE USING TRANSPARENT TAPE A PASSPORT PHOTO 2 X 2 OF YOU THAT WAS TAKEN WITHIN THE PAST 6 DATE OF BIRTH SOCIAL SECURITY NUMBER Optional EYE COLOR WEIGHT LBS FT SEX IN RACE A ASIAN B BLACK I INDIAN W WHITE U UNKNOWN Current Permit Valid From MONTHS Through Please sign within the box in presence of official By affixing my signature to this form I certify that the information I have provided in this form is true and correct to the best of my knowledge and belief and that the attached photograph was taken of me within the last 6 months. I am aware that in order to effectuate C. G*S 29-28 the Department of Emergency Services and Public Protection DESPP will be notified by the the proceeding twelve 12 months by order of a probate court. This information will be used by the DESPP in order to fulfill its obligations under C. G*S* Section 29-28. 00 Fee Check or money order payable to Treasurer State of Connecticut. DO NOT SEND CASH. Copy of valid photo identification if providing a birth certificate as proof of legal and lawful presence in the United States. Notarization ONLY if renewing by mail* Alien Registration Number if applicable Date of Expiration if AR has exp date FOLD HERE Please check the information below PERMIT ID NUMBER ATTACH IN THIS SQUARE USING TRANSPARENT TAPE A PASSPORT PHOTO 2 X 2 OF YOU THAT WAS TAKEN WITHIN THE PAST 6 DATE OF BIRTH SOCIAL SECURITY NUMBER Optional EYE COLOR WEIGHT LBS FT SEX IN RACE A ASIAN B BLACK I INDIAN W WHITE U UNKNOWN Current Permit Valid From MONTHS Through Please sign within the box in presence of official By affixing my signature to this form I certify that the information I have provided in this form is true and correct to the best of my knowledge and belief and that the attached photograph was taken of me within the last 6 months. Notarization ONLY if renewing by mail* Alien Registration Number if applicable Date of Expiration if AR has exp date FOLD HERE Please check the information below PERMIT ID NUMBER ATTACH IN THIS SQUARE USING TRANSPARENT TAPE A PASSPORT PHOTO 2 X 2 OF YOU THAT WAS TAKEN WITHIN THE PAST 6 DATE OF BIRTH SOCIAL SECURITY NUMBER Optional EYE COLOR WEIGHT LBS FT SEX IN RACE A ASIAN B BLACK I INDIAN W WHITE U UNKNOWN Current Permit Valid From MONTHS Through Please sign within the box in presence of official By affixing my signature to this form I certify that the information I have provided in this form is true and correct to the best of my knowledge and belief and that the attached photograph was taken of me within the last 6 months. I am aware that in order to effectuate C. G*S 29-28 the Department of Emergency Services and Public Protection DESPP will be notified by the the proceeding twelve 12 months by order of a probate court. .