WARNING: The information you provide will be used to determine whether you are prohibited by Federal or State Law from receiving a firearm, or
whether Federal or State Law prohibits the sale or disposition of a firearm to you. Certain violations of the Gun Control Act, 18 U.S.C. § 921 et. seq., are
punishable by up to 15 years imprisonment and/or up to a $250,000 fine. Any person who exports a firearm without a proper authorization from either the
Department of Commerce or the Department of State, as applicable, is subject to a fine of not more than $1,000,000 and up to 20 years imprisonment.
Read the Notices, Instructions, and Definitions on this form. Prepare in original only at the licensed premises (including business
temporarily conducted from a qualifying gun show or event in the same State in which the premises is located) unless the transaction qualifies
under 18 U.S.C. § 922(c). All entries must be handwritten in ink unless completed underATF Rul. 2016-2. PLEASE PRINT.