Acknowledgment of Receipt of Required Notices

The Monroe County Clerk’s Office will begin processing the issuance of your permit upon receipt of this form.  Please allow up to four (4) weeks from the date that you completed this form to receive your permit. Your carry number is identified in your approval letter from the Judge and is formatted XXX-XX (i.e. 450-23).

You can also download this form and mail it to the Monroe County Pistol Permit Unit at the County Office Building, 39 West Main Street Room 101, Rochester, New York 14614.

By signing below, you are attesting, pursuant to Penal Law 400.00(18), that you received a Monroe County Pistol Permit approval letter and the statutorily mandated notifications outlining: (a) grounds for revocation and information regarding sensitive and restricted locations where firearm possession is prohibited; and (b) requirements for safe storage.