Is the person acquiring the firearm (Transferee) a FFL?
Transferee's Name and Address
(Include trade name, if any) (See instructions 2d)
Is the person selling or otherwise disposing of a firearm (Transferor), including applying to transfer a firearm, a FFL?
Transferor's Name and Address
(Include trade name, if any) (Executors: see instructions 2k)
Number, Street, City, State and Zip Code of Residence (or Firearms Business Premises)
Description of Firearm
(See instructions 2m)
Name and Address of Maker, Manufacturer and/or Importer of Firearm
Law Enforcement Notification
(See instructions 2f)
Answer questions 14.a. through 14.h. Answer questions 16, 17, 18, 19 and 20, if applicable. For any "Yes" answer the transferee shall provide details on a separate sheet.
(See instructions 7b and definitions)
14a. 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?
(See definition 1m)
14b. Have you ever been convicted in any court for 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?
(See definition 1m)
14c. Are you a fugitive from justice?
(See definition 1s)
14d. 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 or decriminalized for medicinal or recreational purposes in the state where you reside.
14e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution?
(See definitions 1n and 1o)
14f. Have you been discharged from the Armed Forces under dishonorable conditions?
14g. 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?
(See definition 1p)
14h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence?
(See definition 1q)
16. Social Security Number
(See definition 2h)
Date of Birth
18a. Country of Citizenship
(Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 1r)
Are you a citizen of the United States of America?
Are you a citizen of any other country?
Other Country/Countries (specify)?
18b. State of Birth
18c. Country of Birth
18d. Have you ever renounced your United States citizenship?
18e. Are you an alien Illegally or unlawfully in the United States?
18f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
18f.2. If "yes", do you fall within any of the exceptions stated in the instructions? Attach the documentation to the application
19. If you are an alien. record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or I94#):
20. Have you been issued a Unique Personal Identification Number (UPIN)?
(See instruction 2h)
If YES, enter the UPIN otherwise leave empty:
Provide the full name below for each Responsible Person associated with the applicant trust or legal entity.
Please note that a completed Form 5320.23, National Firearms Act (NFA) Responsible Person Questionnaire, must be submitted with the Form 4 application for each Responsible Person.
ATF E-Form 5320.23 Responsible Persons (None)
Name and Home Address of Responsible Person
Law Enforcement Notification
(See instructions 5)
As a responsible person (see definition 4) of the trust or legal entity identified in Item 2 of this form, I am required to provide notification of the proposed making or acquisition and possession of the firearm described in item 4 of this form by providing a copy of the completed form to the chief law enforcement officer (CLEO) in the agency identified below:
Answer questions 8.a. through 8.h. Answer questions 9 and 10, if applicable. For any "Yes" answer the transferee shall provide details on a separate sheet. (See definitions 8-14)
8a. 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?
(See definition 8)
8b. Have you ever been convicted in any court for 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?
(See definition 8)
8c. Are you a fugitive from justice?
(See definition 13)
8d. 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 or decriminalized for medicinal or recreational purposes in the state where you reside.
8e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution?
(See definitions 9 and 10)
8f. Have you been discharged from the Armed Forces under dishonorable conditions?
8g. 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?
(See definition 11)
8h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence?
(See definition 14)
9a. Country of Citizenship
(Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 12)
Are you a citizen of the United States of America?
Are you a citizen of any other country?
Other Country/Countries (specify)?
9d. Have you ever renounced your United States citizenship?
9e. Are you an alien Illegally or unlawfully in the United States?
9f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
9f.2. If "yes", do you fall within any of the exceptions stated in the instructions? Attach the documentation to the application
10. If you are an alien. record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or I94#):
