Fillable Application For Federal Firearms License (Page 7 of 8) in pdf

Give Full Details on a Separate Sheet for All "Yes" Answers in Items 12 and 13.

Yes

12. Is Applicant or

A. Charged by information or under indictment in any court for a felony, or any other crime, for which the

any Person

judge could imprison you for more than one year?¹

Named in Item

B. A fugitive from justice?

9 Above:

C. An alien who is illegally or unlawfully in the United States?

D. Under 21 years of age?

E. An unlawful user of, or addicted to, marijuana, or any depressant, stimulant or narcotic drug, or any other

controlled substance?

F. Subject to a court order restraining him/her from harassing, stalking or threatening his/her child or an

intimate partner or child of such partner?

13. Has Applicant

A. Been convicted in any court of a felony, or any other crime, for which the judge could have imprisoned

or any Person

you for more than one year, even if you received a shorter sentence including probation?²

Named in Item

B. Been discharged from the armed forces under dishonorable conditions?

9 Ever:

C. Been adjudicated as a mental defective, which includes having been adjudicated incompetent to manage

your own affairs, or been committed to a mental institution?

D. Renounced United States citizenship?

E. Been convicted in any court of a misdemeanor crime of domestic violence? (See Definition #3.)

¹ Information - A formal accusation of a crime made by a prosecuting attorney, as distinguished from an indictment presented by a grand jury.

² You may answer NO if (a) you have been pardoned for the crime or (b) the conviction has been expunged or set aside or (c) your civil rights have been

restored AND you are not prohibited from possessing or receiving any firearms under the law where the conviction occurred.

14. Applicant Certification (Please read and initial each box)

The activity to be conducted under the Federal firearms license is not prohibited by State or local law at the premises shown in Item 3.

This includes compliance with zoning ordinances.

Within 30 days after the application is approved, the activity will comply with the requirements of State and local law applicable to the

conduct of business.

Activity will not be conducted under the license until the requirements of State and local law applicable to the business have been met.

A completed copy of this form has been sent or delivered to the Chief Law Enforcement Officer of the locality in which the premises is

located. See instruction 3.

Name of Chief Law Enforcement Officer:

Address of Chief Law Enforcement Officer (Include number, street, city, county, State and ZIP Code)

15. Certification: Under the penalties imposed by 18 U.S.C. 924, I declare that I have examined this application and the documents submitted in

support thereof, and to the best of my knowledge and belief, they are true, correct and complete. This signature, when presented by a duly

authorized representative of the Department of Justice, will constitute consent and authority for the appropriate Department of Justice

representative to examine and obtain copies and abstracts of records and to receive statements and information regarding the background of

all responsible persons. Specifically, I hereby authorize the release of the following data or records to ATF: Employment information,

military information/records, medical information/records, police and criminal records.

Title

Date

Sign

►

Here

For ATF Use Only

Reasons for Denial of Application

16. Application is

Approved

Denied

Date

Signature of Licensing Official

Information for the Chief Law Enforcement Officer

This form provides notification of a person's intent to apply for a Federal firearms license. It requires no action on your part. However, should you have

information that may disqualify the person from obtaining a Federal firearms license, please contact the Federal Firearms Licensing Center at

1-866-662-2750. A "Yes" answer to items #11, #12, and #13 could disqualify a person for a license. Also, ATF may not issue a license if the activity

would be in violation of State or local law.

ATF E-Form 7CR (5310.16)

Copy 2- CLEO

Revised May 2005