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  • Bureau of Alcohol, Tobacco, Firearms and Explosives

  • Firearms Transaction Record

  • Section A - Must Be Completed Personally By Transferee/Buyer

  • 1. Transferee's/Buyer's First Name *
  • 1. Transferee's/Buyer's Middle Name *
  • 1. Transferee's/Buyer's Last Name *
  • 2. Current Residence Street Address *
  • 2. City *
  • County *
    ZIP Code
  • 6. Sex *
    Male Female
  • Place of Birth - U.S. City and State or Foreign Country *
  • Height *
  • Height *
  • Weight *
  • Birth Month *
    (01 through 12)
  • Birth Day *
    (01 through 31)
  • Birth Year *
    Four Digit Number
  • 10.a. Ethnicity *
    Hispanic or Latino Not Hispanic or Latino
  • 10.a. Race *
    American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
  • 11. Answer the following questions by checking or marking "yes" or "no" in the boxes to the right of the questions. *
      Yes No
    Are you the actual transferee/buyer of the firearm(s) listed on this form? Warning: You are not the actual transferee/buyer if you are
    acquiring the firearm(s) on behalf of another person. If you are not the actual transferee/buyer, the licensee cannot transfer the f irearm(s) to you.

    b. Are you under indictment or information in any court for a felony, or any other crime for which the judge could imprison you for more than one year? c. Have you ever been convicted in any court of a felony, or any other crime for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation? d. Are you a fugitive from justice?
    e. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
    Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized.

    f. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? g. Have you been discharged from the Armed Forces under dishonorable conditions? h. Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an intimate partner or child of such partner? i. Have you ever been convicted in any court of a misdemeanor crime of domestic violence?
  • 12.a. Country of Citizenship: Check/List more than one, if applicable. Nationals of the United States may check U.S.A *
    United States of America U.S.A
  •   Yes No 12.b. Have you ever renounced your United States citizenship? 12.c. Are you an alien illegally or unlawfully in the United States? 12.d.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
  • 13. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or I94#):
  • Submit
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