Form Atf F 1 - Application To Make And Register A Firearm - 1997

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OMB No. 1512-0024 (12/31/2000)

DEPARTMENT OF THE TREASURY

1. TYPE OF APPLICATION (Check one)

BUREAU OF ALCOHOL, TOBACCO AND FIREARMS

APPLICATION TO MAKE AND REGISTER A FIREARM

a. TAX PAID. Submit with your application a

check or money order for $200 made paya-

(Submit in duplicate. See Instructions attached.)

ble to the Department of the Treasury. Upon

TO: National Firearms Act Branch, Bureau of Alcohol, Tobacco and Firearms, Washington, DC 20226

approval of the application, this office will

The undersigned hereby makes application, as required by Sections 5821 and 5822 of the National Fire-

acquire, affix, and cancel the required “Na-

arms Act, Title 26 U.S.C., Chapter 53, to make and register the firearm described below.

tional Firearms Act: stamp for you.

APPLICATION IS MADE BY:

TRADE NAME (If any)

b. TAX EXEMPT because firearm is being

INDIVIDUAL

BUSINESS

GOVERNMENT

made on behalf of the United States, or any

FIRM

ENTITY

department, independent establishment, or

agency thereof.

3a. APPLICANT’S NAME AND MAILING ADDRESS (Type or print below and between the dots)

c. TAX EXEMPT because firearm is being

made by or on behalf of any State or pos-

session of the United States, or any political

subdivison thereof, or any official police or-

ganization of such a government entity en-

gaged in criminal investigations.

IF P.O. BOX IS SHOWN ABOVE, STREET ADDRESS MUST BE GIVEN HERE

COUNTY

IMPORTANT: COMPLETE THE REVERSE SIDE. INDIVIDUALS (INCLUDING LICENSE COLLECTORS)

TELEPHONE AREA CODE AND NUMBER

MUST ALSO SUBMIT, IN DUPLICATE, FBI FORM FD-258, FINGERPRINT CARD.

4. DESCRIPTION OF FIREARM (Complete items a through i)

d. MODEL

NAME AND LOCATION ORIGINAL MANUFACTURE

TYPE OF FIREARM TO BE

CALIBER,

OF FIREARM (RECEIVER) (If prototype, furnish

MADE (Shortbarreled rifle, ma-

GAUGE

LENGTH e.. OF BARREL:

plans and specifications) (See Instruction 2f.)

chine gun, destructive device,

OR SIZE

(inches)

(Specify)

etc.)

f. OVERALL:

SERIAL NUMBER (See Instruction 2g.)

h. ADDITIONAL DESCRIPTION (Include all numbers and other identifying

STATE WHY YOU INTEND TO MAKE FIREARM (Use additional sheet if

data which will appear on the firearm)

necessary)

5. APPLICANT’S FEDERAL FIREARMS LICENSE (If any)

SPECIAL (OCCUPATIONAL) TAX STATUS

(Give complete 15-digit number)

ATF IDENTIFICATION NO.

CLASS

FIRST 6 DIGITS

2 DIGITS

5 DIGITS

EMPLOYER’S IDENTIFICATION NUMBER (If applicable)

IMPORTANT: GIVE FULL DETAILS ON SEPARATE SHEET FOR ALL "YES" ANSWERS IN ITEMS 8 AND 9

8. IS APPLICANT

YES

NO 9. HAS APPLICANT

YES

a. Charged by information or under indictment in any court for a crime for

a. Been convicted in any court of a crime for which the judge could have

which the judge could imprison him/her for more than one year. An infor-

imprisoned him/her for more than one year, even if the judge actually

mation is a formal accusation of a crime made by a prosecuting attorney.

gave him/her a shorter sentence?

b. Been discharged from the armed forces under dishonorable

b. A fugitive from justice?

conditions?

c. An alien who is illegally in the United States?

c. Been adjudicated mentally defective or been committed to a

d. Under 21 years of age?

mental institution?

e. An unlawful user of or addicted to, marijuana, or any depres-

d. Renounced his or her United States citizenship?

sant, stimulant, or narcotic drug, or any other controlled sub-

e. Been convicted in any court of a misdemeanor crime of domestic vio-

stance?

lence? This includes any misdemeanor conviction involving the use

f. Subject to a court order restraining him/her from harassing,

or attempted use of physical force committed by a current or former

stalking or threatening an intimate partner or child of such

spouse, parent, or guardian of the victim or by a person with a similar

partner? (See Instruction 5, paragraph 8)

relationship with the victim. (See Definition 1d.)

UNDER PENALTIES OF PERJURY, I DECLARE that I have examined this application, including accompanying documents, and to the best of my knowledge

and belief it is true, accurate and complete and the making and possession of the firearm described above would not constitute a violation of Chapter 44, Title

18, U.S.C., Chapter 53, Title 26, U.S.C., or any provisions of State or local law.

10. SIGNATURE OF APPLICANT

11. NAME AND TITLE OF AUTHORIZED OFFICIAL OF FIRM OR CORPORATION

12. DATE

(If applicable)

THE SPACE BELOW IS FOR THE USE OF THE BUREAU OF ALCOHOL, TOBACCO AND FIREARMS

STAMP NUMBER

By authority of the Director, Bureau of Alcohol, Tobacco and Firearms, this application has been examined and the applicant’s

making and registration of the firearm described above is:

APPROVED (With the following conditions, if any)

DISAPPROVED (For the following reasons)

ATF F 1 (5320.1) (1-97) PREVIOUS EDITIONS ARE OBSOLETE