Form Sp-115 - Machine Gun Registration Application - Department Of State Police
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1
2SP-115 Revised May 1, 2007
APPLICATION MADE BY:
OFFICIAL USE ONLY
Application for Machine Gun Registration
I
NDIVIDUAL
MG-__________________
Commonwealth of Virginia
B
F
USINESS
IRM
REGISTRATION NUMBER
Department of State Police
G
E
OVERNMENT
NTITY
SEE INSTRUCTIONS ON BACK OF FORM
NEW
DUPLICATE
TRANSFER
TEMPORARY
PART A
Applicant Information
,
,
FIRST NAME
MIDDLE NAME
LAST NAME
,
,
,
STREET ADDRESS
CITY
STATE
ZIP CODE
,
MAILING ADDRESS
IF DIFFERENT THAN STREET ADDRESS
ADDRESS WHERE THE MACHIINE GUN IS PHYSICALLY LOCATED IF OTHER THAN STREET ADDRESS LISTED ON THIS APPLICATION
+
AREA CODE
TELEPHONE NUMBER
DATE OF BIRTH
OCCUPATION
(
)
(
)
BUSINESS FIRM OR GOVERNMENT ENTITY NAME
IF APPLICABLE
BUSINESS FIRM OR GOVERNMENT ENTITY ADDRESS
IF APPLICABLE
(
) (
)
(
)
FIREARMS DEALER IDENTIFICATION NUMBER
DIN
IF APPLICABLE
DIN NAME AND ADDRESS
IF APPLICABLE
PART B
Machine Gun Information
(
)
(
,
,
,
)
MACHINE GUN ACQUIRED FROM
FULL NAME OF INDIVIDUAL OR COMPANY
MACHINE GUN ACQUIRED FROM
STREET ADDRESS
CITY
STATE
ZIP
(
18.2-291
)
DATE ACQUIRED OR DATE TRANFERRED TO VIRGINIA
PURPOSE ACQUIRED FOR
MUST COMPLY WITH SECTION
OF THE CODE OF VIRGINIA
/
MACHINE GUN MAKE
MODEL NAME
CALIBER
MODEL NUMBER
SERIAL NUMBER
(
,
,
)
NAME OF ORIGINAL MANUFACTURER OR IMPORTER
ADDRESS OF ORIGINAL MANUFACTURER OR IMPORTER
STREET ADDRESS
CITY STATE
ZIP
PART C
Temporary Registration
(Part A and Part B must be completed.)
BEGINNING AND END DATE MACHINE GUN WILL BE IN VIRGINIA
APPLICATION MUST BE NOTARIZED
I________________________________________ attest that the information contained herein is true and accurate to the best of my knowledge.
PRINT NAME
_______________________________________________
SIGNATURE OF APPLICANT
____________________
/
______________________
STATE OF
COUNTY
CITY OF
(Seal)
___
__________
______
SUBSCRIBED AND SWORN TO BEFORE ME THIS
DAY OF
YEAR
_____
_______
_______
________________________________________________
MY COMMISSION EXPIRES
DAY OF
YEAR
SIGNATURE OF NOTARY PUBLIC
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