Connecticut PDFs
Homepage ➾ Fill Your Connecticut Fpd 124 Form
Article Structure

The Connecticut FPD 124 form serves as a crucial tool for precious metal dealers operating within the state, particularly in Fairfield. This form, known as the Precious Metal Dealers Weekly Report, must be submitted weekly to the Fairfield Police Department. Compliance with this requirement is essential, as failure to submit the form can lead to the revocation of a dealer's license. The form captures vital business information, including the dealer's name, owner's name, address, and telephone number. It requires detailed documentation of each transaction conducted during the reporting week, including the date, time, and nature of the transaction, whether it involved a pledge or sale. Dealers must provide comprehensive descriptions of items, including brand names, serial numbers, and any distinctive markings. Additionally, the form mandates that dealers collect and report specific identifying information about the sellers or pledgers, such as their full name, residence, and physical characteristics, including race, height, and eye color. Notarization of the completed form is also required, ensuring that the information is verified and accurate. Thus, the FPD 124 form not only facilitates transparency in the precious metals market but also upholds legal standards set forth by Connecticut's statutes.

Documents used along the form

The Connecticut Fpd 124 form is essential for precious metal dealers to report their weekly transactions. Along with this form, several other documents may be necessary to ensure compliance with local laws and regulations. Below is a list of related forms and documents commonly used in conjunction with the Fpd 124 form.

  • Dealer License Application: This form is required for individuals or businesses seeking to obtain a license to operate as a precious metal dealer. It includes personal information, business details, and background checks.
  • Power of Attorney Form: This crucial document enables individuals to designate someone to act on their behalf in legal matters. To learn more and access the necessary template, visit Texas Documents.
  • Transaction Record Log: Dealers maintain this log to track daily transactions. It serves as a detailed account of all items bought or sold, including dates and descriptions.
  • Identification Verification Form: This document collects information about sellers or pledgers, including their identification details. It ensures that dealers have verified the identity of individuals involved in transactions.
  • Notarization Form: Often required for various documents, this form confirms that signatures are authentic and that the parties involved have sworn to the truthfulness of the information provided.
  • Sales Tax Return: Dealers must report sales tax collected on transactions. This form details the amount of tax collected and is submitted to the state tax authority.
  • Annual Financial Statement: This document provides a summary of the dealer's financial activities over the year. It may be required for license renewal or compliance checks.
  • Incident Report Form: If any issues arise during transactions, such as theft or disputes, this form is used to document the incident and notify law enforcement if necessary.

Having these forms ready can help ensure that precious metal dealers operate smoothly and remain compliant with state regulations. It's important to stay organized and keep accurate records to avoid potential issues.

Download PDF Form

Preview - Connecticut Fpd 124 Form

FAIRFIELD POLICE

100 Reef Road, Fairfield, CT 06824 (203) 254-4840

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 21-11 of the Connecticut General Statutes.

SIGNATURE OF DEALER / PAWNSHOP OPERATOR

DATE

STATE OF CONNECTICUT, COUNTY OFSS.

Subscribed to and sworn before me on this ________ day of ___________________ 20_______.

 

NOTARY PUBLIC

FPD-124

 

 

rev.11/08

commission expires:

 

DATE

 

 

TIME

 

 

 

 

 

 

 

 

TICKET #

 

 

 

 

 

 

 

 

PLEDGE

 

SOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

LAST, FIRST, MI

 

 

 

 

 

 

 

 

 

TYPE OF IDENTIFICATION

PLEDGER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RESIDENCE

#

STREET

 

 

TOWN / CITY

 

STATE

ZIP

IDENTIFICATION NUMBER

SELLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

RACE

SEX

HEIGHT

 

WEIGHT

 

EYES

 

HAIR

PAID BY CHECK NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARTICLE DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

TIME

 

 

 

 

 

 

 

 

TICKET #

 

 

 

 

 

 

 

 

PLEDGE

 

SOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

LAST, FIRST, MI

 

 

 

 

 

 

 

 

 

TYPE OF IDENTIFICATION

PLEDGER

 

 

 

 

 

 

 

 

 

 

RESIDENCE

#

STREET

 

 

TOWN / CITY

 

STATE

ZIP

IDENTIFICATION NUMBER

SELLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

RACE

SEX

HEIGHT

 

WEIGHT

 

EYES

 

HAIR

PAID BY CHECK NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARTICLE DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

TIME

 

 

 

 

 

 

 

 

TICKET #

 

 

 

 

 

 

 

 

PLEDGE

 

SOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

LAST, FIRST, MI

 

 

 

 

 

 

 

 

 

TYPE OF IDENTIFICATION

PLEDGER

 

 

 

 

 

 

 

 

 

 

RESIDENCE

#

STREET

 

 

TOWN / CITY

 

STATE

ZIP

IDENTIFICATION NUMBER

SELLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

RACE

SEX

HEIGHT

 

WEIGHT

 

EYES

 

HAIR

PAID BY CHECK NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARTICLE DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

TIME

 

 

 

 

 

 

 

 

TICKET #

 

 

 

 

 

 

 

 

PLEDGE

 

SOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

LAST, FIRST, MI

 

 

 

 

 

 

 

 

 

TYPE OF IDENTIFICATION

PLEDGER

 

 

 

 

 

 

 

 

 

 

RESIDENCE

#

STREET

 

 

TOWN / CITY

 

STATE

ZIP

IDENTIFICATION NUMBER

SELLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

RACE

SEX

HEIGHT

 

WEIGHT

 

EYES

 

HAIR

PAID BY CHECK NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARTICLE DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

TIME

 

 

 

 

 

 

 

 

TICKET #

 

 

 

 

 

 

 

 

PLEDGE

 

SOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

LAST, FIRST, MI

 

 

 

 

 

 

 

 

 

TYPE OF IDENTIFICATION

PLEDGER

 

 

 

 

 

 

 

 

 

 

RESIDENCE

#

STREET

 

 

TOWN / CITY

 

STATE

ZIP

IDENTIFICATION NUMBER

SELLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

RACE

SEX

HEIGHT

 

WEIGHT

 

EYES

 

HAIR

PAID BY CHECK NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARTICLE DESCRIPTION

Common Questions

What is the purpose of the Connecticut FPD 124 form?

The Connecticut FPD 124 form is a weekly report required from precious metal dealers. This form documents all transactions involving the buying, selling, or pledging of precious metals. It is essential for maintaining transparency and compliance with local regulations. Failure to submit this form weekly can lead to serious consequences, including the revocation of the dealer's license.

How should I fill out the Connecticut FPD 124 form?

The form must be filled out either by typing or by legibly printing all information. You need to complete the front and back of the sheet, ensuring that all required details are included. If additional pages are necessary, they must be consecutively numbered. The top section of the first page should be completed, while the second page should contain detailed transaction information. Each transaction must include specifics about the item and the seller, including identification details.

What information is required for each transaction listed on the form?

For each transaction, you must provide the date and time, ticket or receipt number, and a complete description of the item. This includes the brand name, make, serial number, and any distinguishing features. Additionally, you need to record the seller's full name, residence, and a verifiable form of identification, such as a driver’s license. A detailed description of the seller, including race, date of birth, height, weight, eye color, and hair color, is also required.

Is notarization necessary for the Connecticut FPD 124 form?

Yes, notarization is a crucial step. The dealer or pawnbroker must sign the form, confirming that the information provided is accurate and complete for the week ending as indicated. This signature must be notarized, which means a notary public must witness the signing and provide their seal. This process adds a layer of authenticity and accountability to the report.

What are the consequences of failing to submit the form on time?

Failing to submit the Connecticut FPD 124 form weekly can result in severe penalties. The most significant consequence is the potential revocation of the dealer's license. This loss not only affects business operations but can also damage the dealer's reputation in the community. It is vital to adhere to the submission schedule to avoid these repercussions.

Common PDF Forms

State of Ct Property Liens - The form can be found on the Connecticut Secretary of State's website for reference.

For those seeking to understand the complexities of legal arrangements, the essential guide to Power of Attorney is invaluable. This document empowers individuals to delegate decision-making authority, ensuring that their preferences are honored during critical times.

How Much Does It Cost to Register a Car in Ct - Failure to confirm employment can lead to denial of the permit application.

Guide to Filling Out Connecticut Fpd 124

Completing the Connecticut FPD 124 form is essential for precious metal dealers to report their weekly transactions to the Fairfield Police Department. Ensure that all information is accurate and legible, as this form must be submitted weekly. Following the steps outlined below will help you fill out the form correctly and avoid any potential issues with your dealer's license.

  1. Begin by entering the week ending date at the top of the form.
  2. Fill in the name of your business and the owner's name.
  3. Provide the business address, including street number and name, city (Fairfield), and state (CT).
  4. Enter your telephone number in the designated space.
  5. Ensure all information is typed or printed clearly on the form.
  6. Complete the reverse side of the form by listing each transaction. Include the following details for each transaction:
    • Date and time of the transaction
    • Ticket or receipt number (indicating whether it was a pledge or a sale)
    • A complete description of the item, including brand name, make, serial number, model number, and any other identifying marks
    • Seller/Pledger's full name and residence, along with verifiable identification details
    • Description of the Seller/Pledger, including race, date of birth, height, weight, eye color, and hair color
  7. If you need more than one page, number the pages consecutively and fill out page 2 completely.
  8. After completing the form, sign it to certify that the information is accurate and complete.
  9. Find a notary public to notarize the form. They will need to witness your signature and provide their seal.

After filling out the form, make sure to keep a copy for your records. Submit the completed and notarized form to the Fairfield Police Department by the required deadline to ensure compliance and maintain your dealer's license.

Dos and Don'ts

When filling out the Connecticut Fpd 124 form, it's essential to follow certain guidelines to ensure the process goes smoothly. Here are seven important do's and don'ts to keep in mind:

  • Do type or legibly print all information on the form.
  • Don't forget to complete both the front and rear of the sheet.
  • Do sign and notarize the form, ensuring the notary seal is included.
  • Don't leave any sections blank; fill in all required fields completely.
  • Do use consecutive numbering if multiple pages are needed for the week.
  • Don't overlook the details for each transaction; include all necessary descriptions.
  • Do ensure that the Seller/Pledger's identification is verifiable and complete.

Following these guidelines will help you avoid potential issues and ensure compliance with the reporting requirements.