Transferee's / Buyer's Full Name

Current Residence Address
(U.S. Postal abbreviations are acceptable. Cannot be a post office box.)

Official Military Orders Establishing Permanent Change of Station (PCS)

Place of Birth

Personal Information

(Select one or more race below. Ethnicity and race must be answered.)

Citizenship Status

(Check / List more than one, if applicable. Nationals of the United States may check U.S.A.)

Questionnaire

21.a Are you the actual transferee/buyer of the firearm(s) listed on this form and any continuation sheet(s) (ATF Form 5300.9A)? Warning: You are not the actual transferee/buyer if you are acquiring the firearm(s) on behalf of another person. If you are not the actual transferee/buyer, the licensee cannot transfer the firearm(s) to you. Exception: If you are only picking up a repaired firearm(s) for another person, you are not required to answer 21.a. and may proceed to question 21.b.
(See Instructions for Question 21.a.)
21.b Are you under indictment or information in any court for a felony, or any other crime for which the judge could imprison you for more than one year, or are you a current member of the military who has been charged with violations of the Uniform Code of Military Justice and whose charges have been referred to a General Court-Martial?
(See Instructions for Question 21.b.)
21.c Have you ever been convicted in any court, including a military court, of a felony, or any other crime for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation?
(See Instructions for Question 21.b.)
21.d Are you a fugitive from justice?
(See Instructions for Question 21.d.)
21.e Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.
21.f Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution?
(See Instructions for Question 21.f.)
21.g Have you ever been discharged from the Armed Forces under dishonorable conditions?
21.h Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an intimate partner or child of such partner?
(See Instructions for Question 21.h.)
21.i Have you ever been convicted in any court of a misdemeanor crime of domestic violence or are you or have you ever been a member of the military and been convicted of a crime that included, as an element, the use of force against a person as identified in the instructions?
(See Instructions for Question 21.i.)
21.j Have you ever renounced your United States citizenship?
21.k Are you an alien illegally or unlawfully in the United States?
21.l.1 Are you an alien who has been admitted to the United States under a nonimmigrant visa?
(See Instructions for Question 21.l.)
21.l.2 If you are such an alien, do you fall within any of the exceptions stated in the instructions ?

Confirm and Agree

If you want to review your answers, click the REVIEW button, otherwise sign the form and then click I AGREE. By doing so, you are certifying that:
My answers in Section B are true, correct, and complete. I have read and understand the Notices, Instructions, and Definitions on ATF Form 4473. I understand that answering "yes" to question 21.a. if I am not the actual transferee/buyer is a crime punishable as a felony under Federal law, and may also violate State and/or local law. I understand that a person who answers "yes" to any of the questions 21.b. through 21.k is prohibited from receiving or possessing a firearm, unless the person answers "yes" to question 21.l.2 and provides the documentation required in 26.d. I also understand that making any false oral or written statement, or exhibiting any false or misrepresented identification with respect to this transaction, is a crime punishable as a felony under Federal law, and may also violate State and/or local law. I further understand that the repetitive purchase of firearms for the purpose of resale for livelihood and profit without a Federal firearms license is a violation of Federal law. (See Instructions for Question 22.)

This will end your session and allow the seller to complete their portion of ths form.

Please sign here

Congratulations! You're all done.

Please let the seller know you are finished.

CONTINUE

**** MAINTENANCE MODE ****

Please Wait....