Fillable Firearms Transaction Record Part I - Over-The-Counter (Page 2 of 4) in pdf

Section B - Must Be Completed By Transferor (Seller)

16. Type of firearm(s) to be transferred:

17. Location of sale if at a gun show. (See Instruction to Transferor 13.)

Handgun

Long Gun

Both

City & State

(city, state)

18a. Type of Identification (e.g., driver's license or other valid government- issued photo identification.) :

Type of Identification

;

Number on Identification

;

Number on Identification:

Expiration Date

Expiration Date of Identification (if any)

. (See Instruction to Transferor 1.)

18b. Aliens only: Types and dates of additional required identification (e.g., utility bills or lease agreements. See Instruction to Transferor 2.)

18c. Nonimmigrant aliens only: Type of documentation showing an exception to the nonimmigrant alien prohibition (e.g., hunting license/permit;

waiver. See Instruction to Transferor 3.)

Question 19, 20, or 21 Must Be Completed Prior To The Transfer Of The Firearm(s) (See Instructions to Transferor 5-7.)

19a. The transferee’s identifying information in Section A of this form was transmitted

19b.

The NICS or state transaction number (if provided) was:

to NICS or the appropriate state agency on

(Date).

Date

NICS Number

19c. The reponse initially provided by NICS or the appropriate state

19d. If initial NICS or state response was “Delayed,” the following response was

agency was:

received from NICS or the appropriate state agency on

Date

(Date)

Proceed

Denied

Delayed

Proceed

Denied

No resolution was

provided within 3 business

days.

19e. The name and Brady identification number of the NICS examiner (if provided)

20.

No NICS check was required because the transfer involved

(optional)

only NFA firearm(s). (See Instruction to Transferor 7.)

(name)

(number)

21.

No NICS check was required because the buyer has a valid permit which qualifies as an exemption to NICS (See Instruction to Transferor

7.)

State Permit Type:

Date of Issuance:

Expiration Date (if any) :

Permit Number:

Section C

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

C immediately prior to the transfer of the firearm(s). (See Instruction to Transferee 3 & Instruction to Transferor 8.)

I certify that the answers I provided to the questions in Section A of this form are still true and correct.

22. Transferee’s Signature

23. Date

Section D

24.

25.

26.

27.

28.

Manufacturer

Model

Serial Number

Type (pistol, revolver,

Caliber or

and/or Importer

rifle, shotgun, etc.)

Gauge

Model

Manufacturer

Serial Number

Type

Caliber

Complete ATF F 3310.4 For Multiple Purchases Of Handguns (See Instruction to Transferor 11.)

30. Federal Firearms License Number (Hand stamp may be

29. Trade/corporate name and address of transferor (Hand stamp may be used.)

used.)

Trade/Corporate Name and Address

FFL

On the basis of (1) the statements in Section A; (2) my verification of identity noted in question 18a and my verification again at the time of transfer (if

the transfer does not occur on the same day the verification was noted in question 18a) ; and (3) the information in the current State Laws and

Published Ordinances, it is my belief that it is not unlawful for me to sell, deliver, transport, or otherwise dispose of the firearm(s) listed on this form to

the person identified in Section A.

The Person Actually Transferring The Firearm(s) Must Complete Questions 31-34.

31. Transferor’s Name (Please print.)

33. Transferor’s Title

32. Transferor’s Signature

34. Date Transfer is

completed

ATF F 4473 (5300.9) PART I (10-2001)