Official Connecticut Fpd 124 Template in PDF
Structure
For precious metal dealers operating in Fairfield, Connecticut, compliance with local regulations is not just a matter of good business practice; it is essential for maintaining your license. The Connecticut FPD 124 form, also known as the Precious Metal Dealers Weekly Report Form, plays a critical role in this process. Each week, dealers must submit detailed reports to the Fairfield Police Department, documenting every transaction involving precious metals. This includes the sale or pledge of items, with specific information required about both the seller and the items themselves. The form demands clarity and accuracy, necessitating that all entries be typed or legibly printed. Dealers must provide a thorough description of each transaction, including the date, time, and ticket or receipt number. Additionally, the seller's identity must be verified through appropriate identification, and demographic details such as race, date of birth, height, and eye color must be included. Notarization is also a key requirement, ensuring that the information reported is both truthful and complete. Failure to submit this form on time can lead to severe consequences, including the potential revocation of a dealer's license. Understanding the FPD 124 form and its requirements is crucial for any dealer looking to operate legally and responsibly in Fairfield.
Connecticut Fpd 124 Example
FAIRFIELD POLICE
100 Reef Road, Fairfield, CT 06824 (203)
PRECIOUS METAL DEALERS WEEKLY REPORT FORM
THESE REPORTS MUST BE SUBMITTED TO THE FAIRFIELD POLICE DEPARTMENT WEEKLY.
FAILURE TO DO SO COULD RESULT IN THE DEALERS LICENSE BEING REVOKED.
BUSINESS INFORMATION
REPORT FOR WEEK ENDING:
PAGE:
OF
NAME:
OWNER'S NAME:
ADDRESS: # STREET
FAIRFIELD, CT
TELEPHONE #:
INSTRUCTIONS
ALL INFORMATION ON THIS FORM SHALL BE EITHER TYPED OR LEGIBLY PRINTED. THE FRONT AND REAR OF THIS SHEET WILL BE FILLED OUT, SIGNED, AND NOTARIZED (SEAL REQUIRED). IF MORE THAN ONE PAGE IS UTILIZED FOR A WEEK, THE PAGES WILL BE CONSECUTIVELY NUMBERED. COMPLETE ONLY THE TOP SECTION OF PAGE ONE AND COMPLETELY FILL IN PAGE 2 OF ANY ADDITIONAL SHEETS.
On the reverse side of this form each and every transaction will be listed. This will include the date and time of the transaction, the ticket/receipt number (indicating pledge or sold), a complete description of the item or article (to include brand name, make, serial number, model number, and any other definitive markings or engravings), the Seller/Pledger's full name and residence as well as verifiable identification (such as motor vehicle operator's license) and a description of the Seller/ Pledger. The description SHALL include Race (W=White, B=Black, H=Hispanic, A=Asian, O=Other), date of birth, height, weight, eye color and hair color.
NOTARIZATION
The information contained on this form represents the total transactions completed by me for the week ending, as indicated above, in compliance with Chapter 409, Section
SIGNATURE OF DEALER / PAWNSHOP OPERATOR |
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STATE OF CONNECTICUT, COUNTY OFSS.
Subscribed to and sworn before me on this ________ day of ___________________ 20_______.
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NOTARY PUBLIC |
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rev.11/08 |
commission expires: |
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RESIDENCE |
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IDENTIFICATION NUMBER |
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SELLER |
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DATE OF BIRTH |
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PAID BY CHECK NUMBER |
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ARTICLE DESCRIPTION
Document Specifications
| Fact Name | Details |
|---|---|
| Form Purpose | The FPD-124 form is a weekly report for precious metal dealers in Fairfield, Connecticut. |
| Submission Requirement | Dealers must submit this report weekly to the Fairfield Police Department. |
| License Consequence | Failure to submit the report may lead to the revocation of the dealer's license. |
| Information Format | All information must be typed or legibly printed on the form. |
| Notarization Requirement | The form must be signed and notarized, with a seal required. |
| Transaction Details | Each transaction must include specific details like date, time, and item description. |
| Identification Verification | Sellers must provide verifiable identification, such as a driver's license. |
| Demographic Information | Dealers must record the seller's race, date of birth, height, weight, eye, and hair color. |
| Governing Law | This form complies with Chapter 409, Section 21-11 of the Connecticut General Statutes. |
| Form Revision | The current version of the form is FPD-124, revised in November 2008. |
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