Atf Form 4473 - Firearms Transaction Record Part I - Over-The-Counter Form (Page 2 of 3) in pdf

I certify that my answers to Section A are true, correct, and complete. I have read and understand the Notices, Instructions, and Definitions

on ATF Form 4473. I understand that answering “yes” to question 11.a. if I am not the actual buyer is a crime punishable as a felony under

Federal law, and may also violate State and/or local law. I understand that a person who answers “yes” to any of the questions 11.b. through

11.k. is prohibited from purchasing or receiving a firearm. I understand that a person who answers “yes” to question 11.l. is prohibited from

purchasing or receiving a firearm, unless the person also answers “yes” to question 12. 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

under Federal law, and may also violate State and/or local law. 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 Instructions for Question 16).

16. Transferee’s/Buyer’s Signature

17. Certification Date

Section B - Must Be Completed By Transferor (Seller)

18. Type of firearm(s) to be transferred (check or mark all that apply):

19. If sale at a gun show or other qualifying event.

Handgun

Long Gun

Other Firearm (Frame, Receiver, etc.

Name of Event

(rifles or

See Instructions for Question 18.)

shotguns)

City, State

20a. Identification (e.g., Virginia Driver’s license (VA DL) or other valid government-issued photo identification.) (See Instructions for Question 20.a.)

Issuing Authority and Type of Identification

Number on Identification

Expiration Date of Identification (if any)

Year

Month

Day

20b. Alternate Documentation (if driver’s license or other identification document does not show current residence address)

20c. All Aliens: Type and dates of documents that establish 90-day residency (e.g., utility bills or lease agreements). (See Instructions for Question 20.c.)

Type(s) of Document

Date(s) of residence indicated on documents

20d. Nonimmigrant Aliens Must Provide: Type of documentation showing an exception to the nonimmigrant alien prohibition. (See Instructions for

Question 20.d.)

Questions 21, 22, or 23 Must Be Completed Prior To The Transfer Of The Firearm(s) (See Instructions for Questions 21, 22 and 23.)

21a. Date the transferee’s identifying information in Section A was transmit-

21b. The NICS or State transaction number (if provided) was:

ted to NICS or the appropriate State agency: (Month/Day/Year)

Month

Day

Year

21c. The response initially provided by NICS or the appropriate State

21d. If initial NICS or State response was “Delayed,” the following

agency was:

response was received from NICS or the appropriate State agency:

Proceed

(date)

Delayed

Proceed

[The firearm(s) may be transferred on

Denied

(date)

(MDI date provided by NICS)

Cancelled

(date)

if State law permits (optional)]

No resolution was provided within 3 business days.

21e. (Complete if applicable.) After the firearm was transferred, the following response was received from NICS or the appropriate State agency on:

Denied

Cancelled

Proceed

(date).

21f. The name and Brady identification number of the NICS examiner (Optional)

(name)

(number)

22.

No NICS check was required because the transfer involved only NFA firearm(s). (See Instructions for Question 22.)

23.

No NICS check was required because the buyer has a valid permit from the State where the transfer is to take place, which qualifies as an

exemption to NICS (See Instructions for Question 23.)

Permit Number (if any)

Issuing State and Permit Type

Date of Issuance (if any)

Expiration Date (if any)

Section C - Must Be Completed Personally By Transferee (Buyer)

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

Section C immediately prior to the transfer of the firearm(s). (See Instructions for Question 24 and 25.)

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

24. Transferee’s/Buyer’s Signature

25. Recertification Date

Transferor (Seller) Continue to Next Page

ATF Form 4473 (5300.9) Part I

Page 2 of 6

Revised August 2008

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