Atf Form 4473 - Firearms Transaction Record Part I - Over-The-Counter Form
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3OMB No. 1140-0020
U.S. Department of Justice
Firearms Transaction Record Part I -
Bureau of Alcohol, Tobacco, Firearms and Explosives
Over-the-Counter
WARNING: You may not receive a firearm if prohibited by Federal or State law. The information you provide will
Transferor's Transaction
be used to determine whether you are prohibited under law from receiving a firearm. Certain violations of the Gun
Serial Number (If any)
Control Act, 18 U.S.C.
921 et. seq., are punishable by up to 10 years imprisonment and/or up to a $250,000 fine.
§§
Prepare in original only. All entries must be handwritten in ink. Read the Notices, Instructions, and Definitions on
this form. “PLEASE PRINT.”
Section A - Must Be Completed Personally By Transferee (Buyer)
1. Transferee’s Full Name
Last Name
First Name
Middle Name (If no middle name, state “NMN”)
2. Current Residence Address (U.S. Postal abbreviations are acceptable. Cannot be a post office box.)
Number and Street Address
City
County
State
ZIP Code
3. Place of Birth
4. Height
5. Weight
6. Gender
7. Birth Date
(Lbs.)
U.S. City and State
-OR-
Foreign Country
Male
Year
Month
Day
Ft.
Female
In.
8. Social Security Number (Optional, but will help prevent misidentification)
9. Unique Personal Identification Number (UPIN) if applicable (See
Instructions for Question 9.)
10. Race (Ethnicity) (Check one or more boxes. See Instructions for Question 10.)
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Asian
White
11. Answer questions 11.a. (see exceptions) through 11.l. and 12 (if applicable) by checking or marking “yes” or “no” in the boxes to the right of the questions.
a. Are you the actual transferee/buyer of the firearm(s) listed on this form? Warning: You are not the actual buyer if you are
Yes
No
acquiring the firearm(s) on behalf of another person. If you are not the actual buyer, the dealer cannot transfer the firearm(s)
to you. (See Instructions for Question 11.a.) Exception: If you are picking up a repaired firearm(s) for another person, you are not
required to answer 11.a. and may proceed to question 11.b.
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
Yes
No
more than one year? (See Instructions for Question 11.b.)
Yes
c. Have you ever 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 Instructions for Question 11.c.
)
Yes
No
d. Are you a fugitive from justice?
Yes
No
e. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
f.
Have you ever been adjudicated mentally defective (which includes a determination by a court, board, commission, or other lawful
Yes
No
authority that you are a danger to yourself or to others or are incompetent to manage your own affairs) OR have you ever been
committed to a mental institution? (See Instructions for Question 11.f.)
Yes
No
g. Have you been discharged from the Armed Forces under dishonorable conditions?
h. Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an intimate partner or child of
Yes
No
such partner? (See Instructions for Question 11.h.)
Yes
No
i.
Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See Instructions for Question 11.i.)
Yes
No
j.
Have you ever renounced your United States citizenship?
Yes
No
k. Are you an alien illegally in the United States?
Yes
No
l.
Are you a nonimmigrant alien? (See Instructions for Question 11.l.) If you answered “no” to this question, do NOT respond to
question 12 and proceed to question 13.
12. If you are a nonimmigrant alien, do you fall within any of the exceptions set forth in the instructions? (If “yes,” the licensee must
Yes
No
complete question 20d.) (See Instructions for Question 12.) If question 11.l. is answered with a “no” response, then do NOT
respond to question 12 and proceed to question 13.
13. What is your State of residence
14. What is your country of citizenship? (List/check more than
15. If you are not a citizen of the United States,
(if any)? (See Instructions for
one, if applicable. If you are a citizen of the United States,
what is your U.S.-issued alien number or
Question 13.)
proceed to question 16.)
admission number?
United States of America
Other (Specify)
Note: Previous Editions Are Obsolete
Transferee (Buyer) Continue to Next Page
ATF Form 4473 (5300.9) Part I
STAPLE IF PAGES BECOME SEPARATED
Revised August 2008
Page 1 of 6
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