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Application For Federal Firearms License

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OMB No. 1140-0038

U.S. Department of Justice

Application for Federal Firearms License

Bureau of Alcohol, Tobacco, Firearms and Explosives

(Collector of Curios and Relics)

1. Applicant's Last Name, First Name, Middle Initial (If partnership, include name of each partner)

For ATF Use Only

2. Applicant's Address (RFD or street number, city, State, and ZIP code)

3. Mailing Address (If different from address in item #2)

4. Name of County in Which Collecting Activity is Located

5. Telephone Number (Include area code)

6. Trade or Business Name, if any

7. Applicant is

An Individual

A Corporation

A Partnership

Other (Specify)

If you checked either corporation or partnership, please list name of corporation or partnership.

8. Payment Information if Paying by Credit/Debit Card

Name as Printed on Your Credit/Debit Card

American

Visa

Mastercard

Discover

Diners Club

Express

Credit/Debit Card Number

Expiration Date (Month and year)

Address:

Credit/Debit Card

Billing Address:

City:

State:

Zip Code:

Please Complete to Ensure Payment is Credited to the Correct Application:

I am Paying the Application Fee for the Following Person, Corporation, or Partnership:

Total Application Fees:

I Authorize ATF to Charge my Credit/Debit Card the Above Amount.

Signature of Cardholder

Date

Your credit/debit card will be charged the above stated amount upon receipt of your application. The charge will be reflected on your credit/debit card

statement. In the event a license/permit is NOT issued, the above amount will be credited to the credit/debit card noted above.

9. Provide the Information Required for Each Individual Owner, Partner, and Other Responsible Person in the Business (Including the individual named in

item #1). See Definition #7 for Responsible Persons. If a Female, List Any Given, Married, and Maiden Names, e.g., "Mary Alice (Smith) Jones," Not

"Mrs. John Jones." (If additional space is needed, use a separate sheet.) Each Responsible Person Must Complete All Information in this Section.

Country of

Home Address

Citizenship

Place of

Position and

List more than one,

Birth

Race and Ethnicity

Social

Please provide every