Firearms Transaction Record Part I - Over-The-Counter
Download a blank fillable Firearms Transaction Record Part I - Over-The-Counter in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Firearms Transaction Record Part I - Over-The-Counter with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4OMB NO. 1512-0129
Transferor's Transaction Serial
DEPARTMENT OF THE TREASURY
Number
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
FIREARMS TRANSACTION RECORD PART I - OVER-THE-COUNTER
WARNING: You may not receive a firearm if prohibited by Federal or State Law. The information you provide will be used to determine
whether you are prohibited under law from receiving a firearm.
Prepare in original only. All entries must be in ink. Read the Important Notices, Instructions and Definitions on this form.
Section A - Must Be Completed Personally By Transferee (Buyer)
1. Transferee’s Full Name (Last, First, Middle)
2. Residence Address (No., Street, City, County, State, ZIP Code; cannot be a post
office box)
Name
Address
6. Birth Date
Place of Birth (City, State or
7. Social Security Number
3.
4.
5.
Height
Male
Height
foreign country)
(Optional, but will help
prevent misidentification.)
Month
Day
Year
Place of Birth
Weight
Month
Day
Weight
Year
Female
8. Race (Ethnicity) (Check one or more boxes)
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Asian
White
State of Residence
9. What is your State of residence (if any) ?
(See Definition 5. If you are not a citizen of the United States, you have a
State of residence only if you have resided in a State for at least 90 days prior to the date of this sale.)
Country of Citzenship
10. What is your country of citizenship? (List more than one, if applicable.)
11. If you are not a citizen of the United States, what is your INS-issued alien number or admission number?
Certification Of Transferee
12. Answer questions 12a through 12l by writing “yes” or “no” in the boxes to the right of the questions.
a. Are you the actual buyer of the firearm(s) listed on this form? Warning: You are not the actual buyer if you are acquiring
the firearm(s) on behalf of another person. If you are not the actual buyer, the dealer cannot transfer the firearm(s) to
Yes
you. (See Important Notice 1 for actual buyer definition and examples.)
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
No
more than one year? (An information is a formal accusation of a crime by a prosecutor. See Definition 3.)
c. Have you been convicted in any court of a felony, or any other crime, for which the judge could have imprisoned you for more
No
than one year, even if you received a shorter sentence including probation? (See Important Notice 6, Exception 1.)
d. Are you a fugitive from justice?
No
e. Are you an unlawful user of, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled
No
substance?
f.
Have you ever been adjudicated mentally defective (which includes having been adjudicated incompetent to manage your own
No
affairs) or have you ever been committed to a mental institution?
g. Have you been discharged from the Armed Forces under dishonorable conditions?
No
h. Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an intimate partner or child
No
of such partner? (See Important Notice 7.)
i.
Have you been convicted in any court of a misdemeanor crime of domestic violence? (See Important Notice 6, Exception 1 and
No
Definition 4.)
j.
Have you ever renounced your United States citizenship?
No
k. Are you an alien illegally in the United States?
No
l.
Are you a nonimmigrant alien? (See Definition 6.)
No
13. If you are a nonimmigrant alien, do you fall within any of the exceptions set forth in Important Notice 6, Exception 2?
Yes
No
Not applicable
(If “yes,” the licensee must complete question 18c.)
I certify that the above answers are true and correct. I understand that answering “yes” to question 12a when I am not the actual buyer
of the firearm is a crime punishable as a felony. I understand that a person who answers “yes” to any of the questions 12b through 12k is
prohibited from purchasing or receiving a firearm. I understand that a person who answers “yes” to question 12l is prohibited from
purchasing or receiving a firearm, unless the person also answers “yes” to question 13.
I also understand that making any false oral or
written statement, or exhibiting any false or misrepresented identification with respect to this transaction, is a crime punishable as a
felony. I further understand that the repetitive purchase of firearms for the purpose of resale for livelihood and profit without a Federal
firearms license is a violation of law. (See Important Notice 8.)
15. Date
14. Transferee’s Signature
ATF F 4473 (5300.9) PART I (10-2001) PREVIOUS EDITIONS ARE OBSOLETE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal