Form-certification for the purchase of a self-defense spray device
Register checked through Jul 29, 2026
No later Register activity identified in this check.
Dates and status
- Compiling agency
- Executive Department
- Text status
- Phase2b Dequote Reversal
- Register checked through
- July 29, 2026/Vol. XLVIII, Issue 30 (2026-07-29)
- Activity status
- No later Register activity identified in this check.
- Source snapshot
- May 19, 2026
CERTIFICATION FOR THE PURCHASE OF A SELF-DEFENSE SPRAY DEVICE (Pursuant to Penal Law, § 265.20(a)(15)(B)) Name of Purchaser: Date of Purchase: / / Last First M.I.
Date of Birth: / / Height: ___ Weight: ___ Social Security No.
Address: Street City State Zip Code County of Residence: ______ Purchaser's Identification: (Driver's License Number or other identification which shows name, date of birth, place of residence) Brand of Self-Defense Spray Devices: Number of Containers Purchased: □ 1 □ 2 Container Net Weight: Name of Vendor: Vendor's License No.: Address: Street City State Zip Code Vendor Type: □ Pharmacists □ Firearms Dealer Signature of Vendor PURCHASER'S VERIFICATION I, ________, do hereby verify that I am over eighteen years of age, and that I have not been convicted of a felony or an assault in New York, or any other State.
I understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
Signature of Purchaser This form approved by the Superintendent of State Police