NYSAFE Act “Opt-Out” Privacy Form


As you know, New York State’s new gun law (NYSAFE Act) includes the ability for pistol permit holders to request that their information be kept private and confidential by completing and submitting a State Police “Opt-Out” privacy form.

According to the NYSAFE Act, Pistol Permit holders will have until April 15, 2013 to submit completed forms to the County Clerk’s Office. Permit holders will still be able to submit completed forms after April 15th but I strongly encourage you to turn in your form as soon as possible.

In order to "Opt-Out" and have your information kept private, please click on the following link to access the form:


Opt-Out Privacy Form


Print out the form, complete it in its entirety, sign it, and drop off or mail the original form to:

Monroe County Clerk Cheryl Dinolfo
c/o Pistol Permit Office
39 W. Main Street, Room 101
Rochester, New York 14614

Forms should be returned to the County in which your permit was issued. We cannot accept forms for other Counties. Your Firearms License # is the Carry number on your permit.

According to the State Police, when you submit your form you will be considered “approved” unless otherwise contacted. Unless your form is denied, there will be no need to follow up with the County Clerk’s Office.


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