New Hampshire Code of Administrative Rules
Saf - Department of Safety
Subtitle Saf-C - Commissioner, Department of Safety
Chapter Saf-C 5000 - DISPLAY FIREWORKS
Part Saf-C 5029 - FORMS
Section Saf-C 5029.02 - DSSP 110

(1) Whether applicant is an individual, partnership, corporation, or limited liability corporation;

(2) Applicant's name, address, date of birth, and present employer;

(3) Employer's address;

(4) Applicant's position;

(5) If the applicant is not an individual, the name and address of the person in charge, the address of the person signing the application, and the date of birth of the person signing the application;

(6) Applicant's certificate of competency for the use of explosives number;

(7) Applicant's telephone number;

(8) Whether the applicant holds a license for use, purchase, and transport of explosives or certificate of competency from another state and if so, the state and license number;

(9) Whether the applicant has ever been refused a license or certificate of competency, and if so, an explanation;

(10) Whether the applicant has ever had a license or certificate of competency revoked or suspended, and if so, an explanation;

(11) Whether the applicant has a criminal record which has not been annulled, and if so, an explanation;

(12) Whether applicant is an American citizen;

(13) Number of years applicant has been engaged in the display, storage, or handling of display fireworks;

(14) All the companies, municipalities, or other organizations applicant has worked for;

(15) Whether the applicant is under indictment for a crime punishable by imprisonment for more than one year;

(16) Whether the applicant is a fugitive from justice;

(17) Whether the applicant is 21 years old or older;

(18) Whether the applicant is a user or addict of marijuana, depressants, stimulants, or narcotics;

(19) Whether the applicant has been adjudicated mentally ill, or has been committed to a mental institution;

(20) Physical characteristics:

(21) The following certification: "I certify that I have read the foregoing application and affirm that every statement contained therein is true and correctly set forth, and I also certify that I am familiar with all state laws, regulations and local ordinances relating to the use, purchase and transport of explosives. (False statements made herein are punishable under N.H. RSA 641:3.)"