Form Atf F 4 (5320.4) - Application For Tax Paid Transfer And Registration Of Firearm - Department Of Treasury

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OMB No. 1512-0027 (08/31/2004)
ATF CONTROL NUMBER
DEPARTMENT OF THE TREASURY
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
SUBMIT IN DUPLICATE TO:
APPLICATION FOR TAX PAID TRANSFER AND REGISTRATION OF FIREARM
2a. TRANSFEREE'S NAME AND ADDRESS (Including tradename, if any) (See instruction 2)
NATIONAL FIREARMS ACT BRANCH
BUREAU OF ALCOHOL, TOBACCO
AND FIREARMS, P.O. BOX 73201
CHICAGO, IL 60673-7201
1. TYPE OF TRANSFER (Check one)
2b. COUNTY
$5
$200
Submit with your application a
3a. TRANSFEROR'S NAME AND ADDRESS (Including trade name, if any) (EXECUTORS: See instruction 2k)
check or money order for the
appropriate amount made payable
to the Bureau of Alcohol, Tobacco
and Firearms. 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 AREA CODE
3d. NUMBER, STREET, CITY, STATE AND
ZIP CODE OF RESIDENCE (OR FIRE-
ARMS BUSINESS PREMISES) IF
3c. IF APPLICABLE: DECEDENT'S NAME, ADDRESS, AND DATE OF DEATH
DIFFERENT FROM ITEM 3a.
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
c.
CALIBER,
a.
NAME AND ADDRESS OF MANUFACTURER AND/
(See instruction 1c)
GAUGE
OR IMPORTER OF FIREARM
LENGTH
e.
OF BARREL: f. OVERALL:
OR 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)
(Give complete 15-digit number) (See instruction 2b)
a.
EMPLOYER IDENTIFICATION
b.
CLASS
NUMBER
First 6 digits
2 digits
2 digits
5 digits
7. TRANSFEROR'S FEDERAL FIREARMS LICENSE (If any)
8.
TRANSFEROR'S SPECIAL (OCCUPATIONAL) TAX STATUS (If any)
b. CLASS
a. EMPLOYER IDENTIFICATION
(Give complete 15-digit number) (See instruction 2b)
NUMBER
5 digits
First 6 digits
2 digits
2 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 AND FIREARMS
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
DATE
ATF F 4 (5320.4) (8-2001) PREVIOUS EDITIONS ARE OBSOLETE

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