Atf E-Form 3310.12 - Report Of Multiple Sale Or Other Disposition Of Certain Rifles

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U.S. Department of Justice

OMB No. 1140-0100

Bureau of Alcohol, Tobacco, Firearms and Explosives

Report of Multiple Sale or Other Disposition

of Certain Rifles

(Please complete all information)

1. Date of Report

2a. Federal Firearms Licensee (FFL) Number

2b. Business or Trade Name and Address (If you have complete information available on a rubber stamp, please place information here.)

2c. Are any of the firearm(s) connected to another multiple sale? (If yes,

specify date)

Yes

Date

3. Rifles Sold or Otherwise Disposed of to the Same Unlicensed Person at One Time or During Any Five Consecutive Business Days

Serial Number

Manufacturer

Importer

Model

Caliber

Disposition Date

4. Transferee's Name (Last, first, middle)

5. Residence Address (Number, street, city, county, state, zip code)

7. Race

6. Sex

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

African American or Black

Hispanic or Latino

White

Other

(Specify)

8. Identification Number

9. Type of Identification

10. ID State

11. Date of Birth

12. Place of Birth (City, county, state, country)

13. If the buyer of the firearms listed in item 4 is a person authorized to act on behalf of a corporation, company, association, partnership or other such

business entity, you must record the following:

Name and Address of Business Entity

14. Additional Information Relating to the Transfer of the Firearms

15. Name of Employee Filling Out This Form

16. Date This Form Was Completed

When Fax is Available, Please Fax to 1-877-283-0288.

ATF E-Form 3310.12

Select One

Revised July 2011