Form Bci-1524a-0310 - Request For Firearm Transaction Background Check - Utah Department Of Public Safety
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1Request for Firearm Transaction Background Check
Brady Section Phone 801-965-4867
Toll Free Phone 1-800-500-4867
Fax 801-969-7265
Toll Free Fax 1-877-879-6228
Dealers: This form must be completely filled out before we can perform a background check. If you fax this form,
upon completion of the check we will fax you back at your dealership fax number below. If a transaction is placed
into Research, you will be contacted at your dealership as soon as the research is complete.
BCI-1524A-0310 10/2011
ATTENTION: JUVENILE RECORD CHECK
Utah State Statute 76-10-503 requires a firearm purchase background check to include a review of the
juvenile record. If you have been convicted as a juvenile of a violent felony within the last 10 years, or a non-
violent felony within the last 7 years, you will be prohibited the purchase of a firearm.
DEALER INFORMATION
Please Print
Dealership Name: _____________________________________
Phone #: _______________________
FFL Number (last five digits): ________________________
Fax #:__________________________
Caller’s Name: __________________________ Search Request #: _______________________________
GUN BUYER INFORMATION
Please Print
Driver’s License
Type of Primary ID: (Please Circle)
State ID Card
UTAH CFP
STATE:_______ID#:______________________________________________Expiration Date: ____________
Buyer’s Name: _______________________________________________Date of Birth: _________________
Address: _________________________________ City__________________ State_______ Zip__________
____________
Social Security #: _________________________Citizenship _____________ Place of Birth
Alien Registration# _________________________________________
Height______ Weight______ Eye Color_____ Hair Color_____ Male____ Female ____ Race ____
(Race must be W=White, B=Black, A=Asian or Pacific Islander, I=Native American or Alaskan Native,
U=Unknown) (Do not use O for Other
Transaction type: (Please Circle)
Handgun Sale (SH)
Long-gun Sale (SL)
Handgun/Long-gun
Other Sale (SO)
Sale (SB)
Handgun Pawn (PH)
Long-gun Pawn (PL)
Handgun/Long-gun
Other Pawn (PO)
Pawn (PB)
Handgun Pre-Pawn
Long-gun Pre-Pawn
Handgun/Long-gun
Other Pre-Pawn
(PPH)
(PPL)
Pre-Pawn (PPB)
(PPO)
FOR BCI USE ONLY
Research_______________ Prohibited_______________Approved_______________
FED / STATE
BCI 1524A-0310 06.2013
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