N.H. Admin. Code § Saf-C 5029.01

Current through Register No. 36, September 5, 2024

Section Saf-C 5029.01 - DSFM 165

(a) Applicants shall supply on form DSFM 165 the following:

(1) Name, address, and date of birth of applicant;

(2) Applicant's present employer, and position;

(3) Employer's address;

(4) Whether applicant holds a license or certificate of competency to conduct fireworks displays from another state, and if so, the state and the license number;

(5) Whether a license or certificate of competency has ever been denied, and if so, an explanation;

(6) Whether any previous license or certificate of competency has ever been revoked or suspended, and if so, an explanation;

(7) Any criminal record that has not been annulled;

(8) Citizenship status;

(9) Number of years engaged in actual fireworks display;

(10) Companies, municipalities, or other organizations that applicant has worked for in this capacity;

(11) Whether applicant is under indictment for a crime punishable by imprisonment for more than one year, and if so, an explanation stating the specific charge, the date of the charge, and the court of jurisdiction, and if yes, an explanation;

(12) Whether applicant is a fugitive from justice, and if yes, an explanation;

(13) Whether applicant is 21 years of age or older;

(14) Whether applicant uses or is addicted to marijuana, depressants, stimulants, or narcotics, and if yes, an explanation;

(15) Whether applicant has ever been adjudicated as mentally ill, or been committed to any mental institution, and if yes, an explanation;

(16) Physical characteristics:

a. Height;

b. Weight;

c. Color of hair; and

d. Color of eyes;

(17) The following certification: "I certify that I have read the foregoing application and affirm that every statement contained herein is true and correctly set forth, and I also certify that I am familiar with all state laws, regulations, and local ordinances relating to display fireworks, for the location in which I intend to conduct operations. (False statements made herein are punishable under N.H. RSA 641:3.)"; and

(18) Signature under penalty of unsworn falsification.

(b) The applicant shall sign the application under penalty of unsworn falsification and the provisions RSA 160-B:6, X.

N.H. Admin. Code § Saf-C 5029.01

#9765-B, eff 8-2-10 (from Saf-C 5003.04(b) and (c) )

Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12124, Effective 3/6/2018, Expires 3/6/2027.