Authorized Instructor Registration Form

2. Pursuant to New York Sate Penal Law §400.00(19), all applicants for a New York Sate Concealed Carry Pistol Permit must complete a minimum of sixteen (16) hours of in-person live curriculum firearm safety training and two (2) hours of a live-fire range training course.  All Livingston County residents wishing to apply for a New York Sate Concealed Carry Pistol Permit will be required to submit a Certification of Completion of Training Form with their application.  

   ** The Livingston County Clerk's website does not certify any individual or entity as a Duly Authorized Instructor, as defined in New York State Penal Law §265.00(19), nor is it an endorsement of any particular course or provider.  

4. First Name*
5. Last Name*
7. Street Number*
8. Street Name*
9. Street Type*
10. Apt #
12. City*
13. State*
14. Zip*
16. Email*
17. Phone # (###-###-####)*
19. Website (optional)

21. I am a Duly Authorized Instructor,  as that term is defined in New York Sate Penal Law §265.00(19), approved by the New York State Division of Criminal Justice Services and New York Sate Police to instruct the concealed carry firearms safety training.  Please include the above individual or entity on the Livingston County Clerk's website and listed as providing the following training:

    (please check one or both)

    
    

23. Yes/No*
    -- Select One --YesNo

    Firearm Safety Course - Classroom

    (option 1) A minimum of sixteen (16) hours of in-person live curriculum that meets or exceeds the requirements set forth in New York Sate Penal Law §400.00(19) and the "Minimum Standards For New York Sate Concealed Carry Firearm Safety Training" issued on August 23, 2022, as amended or updated from time to time, including a written proficiency test to the above-listed applicant that evaluates his/her/their understanding of the requirements set forth in New York Sate Penal Law §400.00(19) and the "Minimum Standards For New York Sate Concealed Carry Firearm Safety Training" issued on August 23, 2022, as amended or updated from time to time.

25. Yes/No*
    -- Select One --YesNo

    Firearm Safety Course - Live Fire

    (option 2) A minimum of two (2) hours of live-fire range training course that meets or exceeds the requirements set forth in New York State Penal Law §400.00(19) and the "Minimum Standards For New York Sate Concealed Carry Firearm Safety Training" issued on August 23, 2022, as amended or updated from time to time.  

27. Sample of Certificate of Completion

    Please upload a sample of a Certificate of Completion from your establishment.  The Livingston County Clerk will maintain a copy on file to ensure those submitted are true.  Thank you, Andrea

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field