Application For Tax Paid Transfer And Registration Of Firearm printable pdf download

OMB No. 1140-0014 (xx/xx/xxxx)

U.S. Department of Justice

Application for Tax Paid Transfer and

Bureau of Alcohol, Tobacco, Firearms and Explosives

Registration of Firearm

ATF Control Number

National Firearms Act Branch

SUBMIT in DUPLICATE to:

Bureau of Alcohol, Tobacco, Firearms and Explosives, P.O. Box 530298, Atlanta, GA 30353-0298

2a. Transferee’s Name and Address (Include trade name, if any) (See instruction 2d)

1. Type of Transfer (Check one)

$200

Submit the appropriate tax payment with

the application. The tax may be paid

2b. County

by credit or debit card, check, or money

INDIVIDUAL

TRUST or LEGAL ENTITY

order. Please complete item 20. Upon

3a. Transferor’s Name and Address (Include trade name, if any) (Executors: see instruction 2k)

approval of the application, we will affix

and cancel the required National Firearms

Act stamp. (See instructions 2b, 2i and 3)

3b. Transferor’s Telephone (Area Code and

Number)

3e. e-mail address

3d. Number, Street, City, State and Zip

3c. If Applicable: Decedent’s Name, Address, and Date of Death

Code of Residence (or Firearms

Business Premises) If Different from

Item 3a.

The above-named and undersigned transferor hereby makes application as required by Section 5812 of the National Firearms Act to transfer and register the firearm described

below to the transferee.

d. Model

Description of Firearm (Complete items a through h) (See instruction 2m)

Name and Address of Maker, Manufacturer and/or

c. Caliber

b. Type of Firearm

Importer of Firearm

(See definitions)

e. Of Barrel:

f. Overall:

Length

Gauge

(Inches)

g. Serial Number

Additional Description or Data Appearing on Firearm (Attach additional sheet if necessary)

Transferee’s Federal Firearms License (If any)

6. Transferee’s Special (Occupational) Tax Status (If any)

(Give complete 15-digit number) (See instruction 2c)

a. Employer Identification Number

b. Class

First 6 digits

2 digits

5 digits

8. Transferor’s Special (Occupational) Tax Status (If any)

Transferor’s Federal Firearms License (If any)

a. Employer Identification Number

b. Class

First 6 digits

2 digits

5 digits

Under Penalties of Perjury, I Declare that I have examined this application, and to the best of my knowledge and belief it is true, correct and complete, and that the transfer

of the described firearm to the transferee and receipt and possession of it by the transferee are not prohibited by the provisions of Title 18, United States Code; Chap 44;

Title 26, United States Code; Chap 53; or any provisions of State or local law.

10. Name and Title of Authorized Official (Print or type) 11. Date

Signature of Transferor (Or authorized official)

The Space Below is for the use of the Bureau of Alcohol, Tobacco, Firearms and Explosives

Stamp Denomination

By Authority of The Director, This Application Has Been Examined, and the Transfer and Registration of the Firearm

Described Herein and the Interstate Movement of that Firearm, When Applicable, to the Transferee are:

Approved (With the following conditions, if any)

Disapproved (For the following reasons)

Signature of Authorized ATF Official

Date

Previous Editions Are Obsolete