National Firearms Act (Nfa) Responsible Person Questionnaire (Page 2 of 4) in pdf

6. Answer questions 6.a. through 6.h. Answer questions 7 and 8 if applicable. For any “Yes” answer the transferee shall provide details on a separate sheet.

(See definitions 8-12)

Yes

a. 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)

b. Have you ever been convicted in any court for a felony, or any other crime, for which the judge could imprison you for more than one year, even if you

received a shorter sentence including probation? (See definition 8)

c. Are you a fugitive from justice? (See definition 13)

d. 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.

e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? (See definitions 9 and 10)

f. Have you been discharged from the Armed Forces under dishonorable conditions?

g. 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)

h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See definition 14)

7a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 12)

United States of America

Other Country/Countries (specify):

Yes

Have you ever renounced Unted States citizenship?

Are you an alien illegally or unlawfully in the United States?

d.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?

d.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the questionnaire

N/A

8. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or 194#):

CERTIFICATION: Under penalties imposed by 18 U.S.C. § 924 and 26 U.S.C. § 5861, I certify that a completed copy of this form has been sent to the chief law

enforcement officer shown in item 5, that the statements contained in this certification, and any attached documents in support thereof, are true and correct to

the best of my knowledge and belief.

Signature of Responsible Person

Date

Instructions

1. Completion: Each responsible person (see definition 4) of a trust or legal entity seeking to make or acquire a National Firearms Act (NFA) firearm shall complete this

form in duplicate.

a. Each responsible person must submit his/her fingerprints and photograph with this form (see below).

b. Please note that this form is not required when the applicant on Form 1, 4 or 5 is an individual.

2. Item 2- Enter the name, trade name (if any) and address of the trust or legal entity identified on the Form 1 (items 3a and b); Form 4 (item 2a); or Form 5 (item 2a)

3. Item 3- Responsible Person information

a. Provide the information for the responsible person in items 3a through 3e.

b. Item 3e - Photograph: The responsible person shall attach, in item 3e on the ATF copy of the form only, a 2-inch by 2-inch frontal view photograph taken within

one year prior to the date of the filing of the form.

4. Firearm information

a. Type of NFA firearm: see definition 5 and as identified in item 4b of Form 1, 4, or 5

b. Name of maker, manufacturer and/or importer: as identified in item 4a of Form 1, 4 or 5

c. Firearm Model: identified in item 4d of Form 1, 4 or 5

d. Caliber or Gauge: identified in item 4c of Form 1, 4 or 5

e. Firearm Serial Number: identified in item 4g of Form 1, 4 or 5

5. Item 5- Law Enforcement Notification: Each responsible person must provide a notification on this form of the proposed making or acquisition of an NFA firearm to

his/her chief law enforcement officer having jurisdiction where the responsible person is located. The chief law enforcement officer is considered to be the

Chief of Police; the Sheriff; the Head of the State Police; or a State or local district attorney or prosecutor.

6. Complete items 6 through 8

7. Fingerprints: The responsible person shall submit, in duplicate with the ATF copy of this form, his or her fingerprints on FBI Form FD-258 and the fingerprints must be

clear for accurate classification and taken by someone properly equipped to take them. No fingerprints are required with the copy of the form sent to the chief law

enforcement officer.

8. State or Local Permit: If the State in which the responsible person resides requires the responsible person to have a State or Local permit or licensee, a copy of the

permit or license must be submitted with this form.

9. Disposition: The ATF copy of the form, with the fingerprints and photograph, shall be submitted with the ATF Form 1, 4 or 5. The other copy shall be directed to the

responsible person’s chief law enforcement officer identified in item 5 of this form.

10. Sign and date the form.

ATF Form 5320. 23

Revised ( )