EFTA00556958.pdf

ACKNOWLEDGMENT OF PERSON AGREEING TO SAFEGUARD FIREARMS) P01.24012 (tif-, 12-111 Name of Applicant / Licen Application / License Num Instruction to Applicant/Licensee; Please ask the person you have designated to safeguard and surrender your firearm(s) in the event of your death or incapacity to complete the information below and sign this acknowledgment before a witness (The p Print Addre Tele • (rant name c7- ;:erson a and surrender his/her firearm(s) in the understand that the above-named applicant'licensee has designated me to safeguard he 'she dies or becom es incapa citated . I agree that upon learnin g of the death or incapacity of the licensee. I will event that 610-5871 or (646) 610-5560. or by calling immediately notify the New York City Police Department's License Division at (646) der his/her firearm(s). the local police precinct, and will follow their directions to safeguard and surren Signature of person agre to safeguard firearm(s): Dater-1 r -D 12- Witnessed by (signature)' Witness' Name (printed Nens: ret2!!! cop:' t .: decummt for yet!r ry.erdE EFTA00556958