National Firearms Act (Nfa) Responsible Person Questionnaire

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OMB No. 1140-00xx (xx/xx/xxxx)
U.S. Department of Justice
National Firearms Act (NFA)
Bureau of Alcohol, Tobacco, Firearms and Explosives
Responsible Person Questionnaire
Complete the form in duplicate. The ATF copy of the form, with fingerprints on Form FD-258 and photograph, will be submitted with the ATF Form 1, 4, or 5 (to the address
shown on the specific form) and the other copy will be directed to the responsible person’s chief law enforcement officer. (See Instructions)
1. Please check the appropriate box to indicate with which ATF form this questionnaire will be submitted.
ATF Form 1
ATF Form 4
ATF Form 5
2. Name and Address of Maker or Transferee (as shown on the ATF Form 1, 4 or 5) (see instruction 2)
3a. Name and Home Address of Responsible Person
3b. Telephone (Area code and Number)
3c. e-mail address
3d. Other names used (including maiden name)
4a. Type of Firearm (see definition 5)
3e. Photograph
4b. Name and Address of Maker, Manufacturer and/or Importer of Firearm
Affix recent
Photograph Here
(Approximately 2” x 2” )
(See instruction 3b)
4c. Firearm Model
4e. Firearm Serial Number
4d. Caliber or Gauge
5. Law Enforcement Notification (See instruction 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 in the agency
identified below:
Agency or Department Name
Name and Title of Official
Address (Street address or P.O. Box, City, State and Zip Code) to which sent (mailed or delivered)
Date Sent to Agency
Information for the Chief Law Enforcement Officer
This form provides notification of the maker or transferee’s intent to make or acquire and possess a National Firearms Act (NFA) firearm. No action on your part is required.
However, should you have information that may disqualify this person from making or possessing a firearm, please contact the NFA Branch at (304) 616-4500 or NFA@atf.
gov. A “Yes” answer to items 6a through 6j (except 6i) and item 7a could disqualify a person from acquiring or possessing a firearm. Also, ATF may not approve an
application if the transfer or possession of the firearm would be in violation of State or local law.
ATF Form 5320. 23
Revised ( )

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