Fort Lee Form 694-1 - Civilian Personnel Weapon Registration printable pdf download

Fort Lee Form 694-1 - Civilian Personnel Weapon Registration

Civilian Personnel Weapon Registration

ARMY REGULATION 190-11 & FORT LEE REGULATION 190-2

PRIVACY ACT STATEMENT

AUTHORITY: Title 10, USC Section 3013, Title 5, USC Section 2951: E.O. 9397 Social Security Number (SSN)

PURPOSE: To document weapons registrations within COPS data base.

ROUTINE USES: Information provided may be further disclosed to Federal, State, and Local law enforcement

agencies, prosecutors, and courts.

DISCLOSURE: Voluntary disclosure. However, failure to provide the information will preclude registration and

authorization to possess a privately owned weapon on a military installation.

COMPLETION INSTRUCTIONS

Please complete sections 1, 2, and 3 on this form completely; failure to provide required information

will result in non-registration.

Upon completion please bring this form to the Weapons Registration Office.

SECTION 1- PERSONAL INFORMATION

NAME:

SSN:

DOB:(day/month/year):

SEX: __ RACE:____ HEIGHT:____ WEIGHT:____ EYECOLOR:____ HAIR COLOR:

RESIDENCE ADDRESS:

PHONE#: (Home or Cell)

SECTION 2 - WEAPON INFORMATION

WEAPON TYPE: (Pistol, Rifle, Shotgun, etc.)

Weapon Storage

TYPE:

MAKE:

MODEL:

CALIBER:

SERIAL#:

BARREL LENGTH:

OVERALL LENGTH

FINISH:

SECTION 3 - INDIVIDUAL CERTIFICATION

I _______________________________certify the following: (Please initial before each statement)

(printed name)

______ 1. I have not been convicted of a felony. (The Federal Gun Control Act of 1968, as

amended in 1996).

(Continued on back)

FORT LEE FORM 694-1, R-NOV 2015

PREVIOUS EDITIONS ARE OBSOLETE

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Fort Lee Form 694-1 - Civilian Personnel Weapon Registration