Atf Form 4 - Application For Tax Paid Transfer And Registration Of Firearm - 2006

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OMB No. 1140-0014 (01/31/2014)

U.S. Department of Justice

Application for Tax Paid Transfer and

Bureau of Alcohol, Tobacco, Firearms and Explosives

Registration of Firearm

ATF Control Number

Submit in Duplicate to:

National Firearms Act Branch

2a. Transferee's Name and Address (Including tradename, if any) (See instruction 2)

Bureau of Alcohol, Tobacco, Firearms

and Explosives, P.O. Box 530298

Atlanta, GA 30353-0298

1. Type of Transfer (Check one)

$200

2b. County

Submit with your application a check or

money order for the appropriate amount

3a. Transferor's Name and Address (Including trade name, if any) (Executors: see instruction 2k)

made payable to the Bureau of Alcohol,

Tobacco, Firearms and Explosives. Upon

approval of this application, this office

will acquire, affix and cancel the required

"National Firearms Act" stamp for you.

(See instructions 2h, 2i and 3.)

3b. Transferor’s Telephone Number and

3d. Number, Street, City, State and Zip Code

Area Code

of Residence (or Firearms Business

Premises) if Different from Item 3a.

3c. If Applicable: Decedent's Name, Address, and Date of Death

The above-named and undersigned transferor hereby makes application as required by Section 5812 of the National Firearms Act to transfer and register the firearm described

below to the transferee.

d. Model

4. Description of Firearm (Complete items a through h)

b. Type of Firearm (See

a. Name and Address of Manufacturer and/or Importer of

c. Caliber,

instruction 1c)

Gauge or

Firearm

Length

e. Of Barrel:

f. Overall:

Size

(Inches)

(Specify)

g. Serial Number

h. Additional Description or Data Appearing on Firearm (Attach additional sheet if necessary)

5. Transferee's Federal Firearms License (If any)

6. Transferee's Special (Occupational) Tax Status (If any)

a. Employer Identification Number

b. Class

(Give complete 15-digit number) (See instruction 2b)

First 6 digits

2 digits

5 digits

(If any)

8. Transferor's Special (Occupational) Tax Status (If any)

Transferor's Federal Firearms License

b. Class

a. Employer Identification Number

(Give complete 15-digit number) (See instruction 2b)

First 6 digits

2 digits

5 digits

Under Penalties of Perjury, I Declare that I have examined this application, and to the best of my knowledge and belief it is true, correct and complete, and that the transfer of the described

firearm to the transferee and receipt and possession of it by the transferee are not prohibited by the provisions of Chapter 44, Title 18, United States Code; Chapter 53, Title 26, United States Code;

or Title VII of the Omnibus Crime Control and Safe Streets Act, as amended; or any provisions of State or local law.

9. Consent to Disclosure of Information to Transferee (See instruction 8) . I Do or Do Not (Circle one) Authorize ATF to Provide Information Relating to this

Application to the Above-Named Transferee .

10. Signature of Transferor (or authorized official)

11. Name and Title of Authorized Official

12. Date

(Print or type)

The Space Below is for the use of the Bureau of Alcohol, Tobacco, Firearms and Explosives

Stamp Denomination

By authority of the Director, This Application has been Examined, and the Transfer and Registration of the Firearm Described

herein and the Interstate Movement of that Firearm, when Applicable, to the Transferee are:

Disapproved (For the following reasons)

Approved (with the following conditions, if any)

Signature of Authorized ATF Official