Atf Form 4473 - Firearm Transaction Record (Page 2 of 6) in pdf

I certify that my answers to Section A are true, correct, and complete. I have read and understand the Notices, Instructions, and Definitions

on ATF Form 4473. I understand that answering "yes" to question 11.a. if I am not the actual buyer is a crime punishable as a felony under

Federal law, and may also violate State andlor local law. I understand that a person who answers "yes" to any of the questions l1.b. through

11.k.

is prohibited from purchasing or receiving a firearm. I understand that a person who answers "yes" to question 11.1. is prohibited from

purchasing or receiving a firearm, unless tbe person also answers "yes" to question 12. I also understand tbat making any false oral or

written statement, or exhibiting any false or misrepresented identification with respect to tbis transaction, is a crime punisbable as a felony

under Federal law, and may also violate State and/or local law. I further understand tbat tbe repetitive purchase of firearms for tbe purpose

of resale for livelihood and profit without a Federal firearms license is a violation of law

(See tllstructiolls!or QllestioIl16).

16. Transferee'slBuyer's Signature

17.

Certification Date

Section B - Must Be Completed By Transferor (Seller)

18. Type of fireann(s) to be transferred (check or mark all that apply):

19. If sale at a gun show or other qualifying event.

Handgun OLong Gun

Other Fireann (Frame, Receiver, etc. Name of Event

(rifles or

See Instructions for Question 18.)

- - - - - - - - - - - - - - - - - - - - -

shotguns)

City, State

20a. Identification (e.g.. Virginia DJiver's license

(VA DL)

or other valid govel71ment-issuedphoto identification.) (See InstructionsjOr Question 2o.a.)

Issuing Authority and Type of Identification

Number on Identification

Expiration Date ofIdentification (ifany)

Month

Day

Year

20b. Alternate Documentation (if driver's license or other identification document does not show current residence address)

20c. All Aliens: Type and dates of documents that establish 90-day residency (e.g., utility bills or lease agreements). (See Instructionsfor Question 20.c.)

Type(s) of Document

Date(s) of residence indicated on documents

20d. Nonimmigrant Aliens Must Provide: Type of documentation showing an exception to the nonimmigrant alien prohibition. (See Instructions for

Question 20.d.)

Questions 21, 22, or 23 Must Be Completed Prior To The Transfer Of The Firearm(s) (See Instructions for Questions 2/, 21

Glul

23.)

21 a. Date the transferee's identifying information in Section

was transmit- 2

b. The NICS or State transaction number (ifprovided) was:

ted to NICS or the appropriate State agency: (MonthiDayIYeaJ)

Month

Day

Year

d. If initial NICS or State response was "Delayed," the following

response was received from NICS or the appropriate State agency:

Proceed

(date)

Denied

(date)

Cancelled

(date)

No resolution was provided within 3 business days,

Delayed

(Thejirearm(s) may be tranl>ferred

011

_ _ _ _ _ _ (MDI date provided by NICS)

ifState law permits (optional)

The response initially provided by NICS or the appropriate State

agency was:

Proceed

Denied

Cancelled

21c.

21e. (Comp/ete ifapplicable.) After the firearm was transferred, the following response was received from NICS or the appropriate State agency on;

(date).

Proceed

Denied

Cancelled

21f. The name and Brady identification number of the NICS examiner (Optional)

(name)

(number)

22.

No NICS check was required because the transfer involved only NFA fireann(s). (See /nsrructionsfor Question 22.)

Pennit Number (ifany)

23.

No NICS check was required because the buyer has a valid pennit from the State where the transfer i to take place, which qualifies as an

exemption to NICS (See Insh'uctions for Question 23.)

Issuing State and Pennit Type

Date ofTssuance (ifany)

Expiration Date (ifany)

Section C - Must Be Completed Personally By Transferee (Buyer)

If the transfer of the fireann(s) takes place on a different day from the date that the transferee (buyer) signed Section A, the transferee must complete

Section C immediately prior to the transfer of the fireann(s). (See Instructions for Question 24 and 25.)

I certify tbat my answers to the questions in Section A of this form are still true, correct and complete.

24. Transferee's/Buyer's Signature

25. Recertification Date

Page 20f6

Transferor (Seller) Continue to Next Page

STAPLE IF PAGES BECOME SEPARATED

ATF Form 4473 (5300.9) Part I

Revised August 2008