Atf Form 4 – Fill Out and Use This PDF

Agency or Department Name

Name and Title of Official

13. Transferee Necessity Statement (See instruction 2e)

I,

, have a reasonable necessity to possess the machinegun, short-barreled rifle,

(Name and Title of Transferee)

b. Have you ever been convicted in any court for 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 definition 1m)

c. Are you a fugitive from justice? (See definition 1s)

15. Photograph

d.

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

Affix a 2” x 2” Photograph here.

recreational purposes in the state where you reside.

e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental

No Stapling. Tape Sides of Photo to the

Application.

institution? (See definitions1n and 1o)

f.

Have you been discharged from the Armed Forces under dishonorable conditions?

1. Photo must have been taken within the

last year.

g. 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 definition 1p)

2. Photo must have been taken in full face

h.

Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See definition 1q)

view without a hat or head covering that

obscures the hair or hairline.

16.

Social Security Number: (See instruction 2h)

Date of Birth:

3. On back of photograph print full name,

last 4 of SSN.

17a. Ethnicity

Hispanic or Latino

17b. Race

American Indian or Alaska Native

Black or African American

White

Not Hispanic or Latino

Asian

Native Hawaiian or Other Pacific Islander

18a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 1r)

United States of America

Other Country/Countries (specify):

18b. State of Birth

18c.Country of Birth

Yes

No

f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?

f.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the application

N/A

19.

If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or 194#):

20.

Have you been issued a Unique Personal Identification Number (UPIN)? (See instruction 2h)

Yes

No If yes please list

ATF Form 4 (5320.4)

ATF Copy

Revised September 2019

o.

Committed to a Mental Institution. A formal commitment of a person to

requirements may answer “no” to this question and are not required to

a mental institution by a court, board, commission, or other lawful authority.

submit the additional documentation under 16.d.2. An alien admitted to the

The term includes a commitment to a mental institution involuntarily. The

United States under a nonimmigrant visa is not prohibited from purchasing,

term includes commitment for mental defectiveness or mental illness. It

receiving, or possessing a firearm if the alien: (1) is in possession of a

also includes commitments for other reasons, such as for drug use. The

hunting license or permit lawfully issued by the Federal Government,

term does not include a person in a mental institution for observation or a

a State, or local government, or an Indian tribe federally recognized by the

voluntary admission to a mental institution.

Bureau of Indian Affairs, which is valid and unexpired; (2) was

admitted to the United States for lawful hunting or sporting purposes; (3)

EXCEPTION NICS Improvement Amendments Act of 2007: A person who

is an official representative of a foreign government who is accredited to

has been adjudicated as a mental defective or committed to a mental institution

the United States Government or the Government’s mission to an

in a state proceeding is not prohibited by the adjudication or commitment if the

international organization having its headquarters in the United States; (4)

person has been granted relief by the adjudicating/committing state pursuant to

is an official representative of a foreign government who is enroute to or from

a qualifying mental health relief from disabilities program. Also, a person who

another country to which that alien is accredited; (5) is an official of a foreign

has been adjudicated as a mental defective or committed to a mental institution

government or a distinguished foreign visitor who has been so designated by the

by a department or agency of the Federal Government is not prohibited by the

Department of State; (6) is a foreign law enforcement officer of a friendly foreign

adjudication or commitment if either: (a) the person’s adjudication or

government entering the United States on official law enforcement business; (7)

commitment was set-aside or expunged by the adjudicating/committing agency;

has received a waiver from the prohibition from the Attorney General of the

(b) the person has been fully released or discharged from all mandatory

United States.

treatment, supervision, or monitoring by the agency; (c) the person was found

by the agency to no longer suffer from the mental health condition that served

s.

Fugitives from Justice. Any person who has fled from any State to avoid

as the basis of the initial adjudication/commitment; or (d) the adjudication or

prosecution for a felony or a misdemeanor, or any person who leaves the State

commitment respectively, is based solely on a medical finding of disability,

to avoid giving testimony in any criminal proceeding. The term also includes

without an opportunity for a hearing by a court, board, commission, or other

any person who knows that misdemeanor or felony charges are pending against

lawful authority, and the person has not been adjudication as a mental defective

such person and who leaves the State of prosecution.

consistent with 922(g)(4) of title 18, United States code; or (e) the person was

granted relief from the adjudicating/committing agency pursuant to a qualified

2. Preparation of Application

mental health relief from disabilities program. Persons who fall within one

Authority. As provided by 26 U.S.C. §§ 5811 and 5812, any person seeking to

of the above exceptions should mark “no” in the applicable box. This exception

a.

to an adjudication or commitment by a Federal department or agency does

transferafirearmmustsubmit,induplicate,aseparateapplicationonthisformforeach

not apply to any person who was adjudicated to be not guilty by reason of

firearm. The transferor must furnish all the information called for, except as noted by

insanity, or based on a lack of mental responsibility, or found incompetent to

instructions within, on this application form. Please note that the form now contains

stand trial, in any criminal case or under the Uniform Code of Military

a 3rd (CLEO) copy of the form for use in compliance with instruction 2f and item 12

Justice.

of the form.

p.

Restraining Order. Under 18 U.S.C. § 922, firearms may not be sold to

b.

Transfer Tax Rates. The transfer tax is $200.00 except when the firearm

or received by persons subject to a court order that: (A) was issued after

is an ‘any other weapon’ where the tax rate is $5.00.

a hearing which the person received actual notice of and had an opportunity

to participate in; (B) restrains such person from harassing, stalking, or

c.

Federal Firearms Licensees. If the transferor or transferee is a Federal Firearms

threatening an intimate partner or child of such intimate partner or person,

licensee (FFL) under the GCA, the licensee’s complete name, trade name (if any),

or engaging in other conduct that would place an intimate partner in

and address shall be entered in items 2a or 3a of this form, respectively. The complete

reasonable fear of bodily injury to the partner or child; and (C)(i) includes a

licensenumberforeachshallbeenteredinitems5and7oftheformandifthelicensee

finding that such person represents a credible threat to the physical safety of

is a special (occupational) taxpayer under the NFA, the licensee’s employer

such intimate partner or child; or (ii) by its terms explicitly prohibits the use,

identification number (EIN) shall be entered in item 6 and 8 of the form, along

attempted use, or threatened use of physical force against such intimate

with the class of special tax paid. IMPORTANTNOTE:The business structure

partner or child that would reasonably be expected to cause bodily injury.

of the licensee shall be described consistently. For example, if the transferor is a sole

An “intimate partner” of a person is: the spouse or former spouse of the

proprietor, item 3a shall reflect the FFL information for the sole proprietor business

person, the parent of a child of the person, or an individual who cohabitates

and item 7 shall reflect the FFL number for that sole proprietor business. Item 8

or has cohabitated with the person.

will reflect the EIN for the sole proprietor business. If the special tax is paid as a

corporation, then it is not valid for the transaction. Similarly, a corporation name

q.

Misdemeanor Crime of Domestic Violence: A Federal, State, local,

shown in item 3a with the FFLnumber and EIN of a sole proprietor will not be valid

tribal offense that is a misdemeanor under the Federal, State, or tribal law

for the transaction.

and has, as an element, the use or attempted use of physical force, or the

Completion of Form (NOTE: if the transferee is a Federal firearms

threatened use of a deadly weapon, committed by a current or former

d.

spouse, parent, or guardian of the victim, by a person with whom the victim

licensee except for a Type 03 licensee, items 12, 13, 14, 15, 16, 17, 18,

shares a child in common, by a person cohabitating with, or has cohabited

19, 20, 21 are required to be completed) .

with the victim as a spouse, parent, or guardian, or by a person similarly

situated to a spouse, parent, or guardian of the victim. The term includes

(1) The transferor shall provide the transferee’s full legal name to include middle and

all misdemeanors that have as an element the use or attempted use of

physical address (no Post Office boxes) in item 2a. If the transferee is a trust or

physical force or the threatened use of a deadly weapon (e.g., assault and

legal entity, show only the complete name of the trust or legal entity and do not

battery), if the offense is committed by one of the defined parties. (See

include any individual names (such as names of trustees or corporate officials).

Exception in the definition of “Prohibited Person”). A person who has

The address shall be the location within the particular state where the firearm

been convicted of a misdemeanor crime of domestic violence also is not

will be maintained for a trust or legal entity. In the case of two or more locations

prohibited unless: (1) the person was represented by a lawyer or gave up the

for a legal entity, the address shown shall be the principal place of business

right to a lawyer; or (2) if the person was entitled to a jury, was tried by a

within the particular state (or principal office, in the case of a corporation).

jury, or gave up the right to a jury trial. Persons subject to this exception

should mark “no” in the applicable box.

(2) If the transferee is an individual, the entire Form 4 shall be completed except for

items21and22. Inaddition,thetransfereemustincludehisorherfingerprintson

r.

Alien Admitted to the United States Under a Nonimmigrant Visa. An

FBI Form FD-258 and his or her photos (see instruction 2g).

alien admitted to the United States under a nonimmigrant visa includes,

among others, persons visiting the United States temporarily for

(3) If the transferee is other than an individual, e.g., a trust or legal entity such as a

business or pleasure, persons studying in the United States who maintain

corporation, the transferee shall not complete items 14, 15, 16, 17, 18, 19 and

a residence abroad, and certain temporary foreign workers. These aliens

20. All other items must be completed including the signing of theTransferee

must answer “yes” to question 16.d.1 and provide the additional

Certification statement by the transferee. See 2.d.5. for Responsible Person

documentation required under question 16.d.2. Permanent resident aliens

Requirements

and aliens legally admitted to the United States pursuant either the Visa

Waiver Program or to regulations otherwise exempting them from visa

ATF Form 4 (5320.4)

Revised September 2019

Agency or Department Name

Name and Title of Official

13. Transferee Necessity Statement (See instruction 2e)

I,

, have a reasonable necessity to possess the machinegun, short-barreled rifle,

(Name and Title of Transferee)

b. Have you ever been convicted in any court for 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 definition 1m)

c. Are you a fugitive from justice? (See definition 1s)

15. Photograph

d.

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.

Affix a 2” x 2” Photograph here.

e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental

No Stapling. Tape Sides of Photo to the

institution? (See definitions1n and 1o)

Application.

f.

Have you been discharged from the Armed Forces under dishonorable conditions?

1. Photo must have been taken within the

g. Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an

last year.

intimate partner or child of such partner?(See definition 1p)

2. Photo must have been taken in full face

h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See definition 1q)

view without a hat or head covering that

Date of Birth:

obscures the hair or hairline.

3. On back of photograph print full name,

last 4 of SSN.

17a. Ethnicity

Hispanic or Latino

17b. Race

American Indian or Alaska Native

Black or African American

White

Not Hispanic or Latino

Asian

Native Hawaiian or Other Pacific Islander

18a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 1r)

United States of America

Other Country/Countries (specify):

18b. State of Birth

18c.Country of Birth

Yes

No

f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?

f.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the application

N/A

19. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or 194#):

20. Have you been issued a Unique Personal Identification Number (UPIN)? (See instruction 2h)

Yes

No If yes please list

ATF Form 4 (5320.4)

ATF Copy 2 - To Be Returned to Registrant

Revised September 2019

Signature of Transferee

Date

Full Name

Full Name

ATF Form 4 (5320.4)

ATF Copy 2 - To Be Returned To Registrant

Revised September 2019

Agency or Department Name

Name and Title of Official

13. Transferee Necessity Statement (See instruction 2e)

I,

, have a reasonable necessity to possess the machinegun, short-barreled rifle,

(Name and Title of Transferee)

17a. Ethnicity

Hispanic or Latino

17b. Race

American Indian or Alaska Native

Black or African American

White

Not Hispanic or Latino

Asian

Native Hawaiian or Other Pacific Islander

18a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See definition 1r)

United States of America

Other Country/Countries (specify):

18b. State of Birth

18c.Country of Birth

Yes

No

f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?

f.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the application

N/A

19. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or 194#):

20. Have you been issued a Unique Personal Identification Number (UPIN)? (See instruction 2h)

Yes

No If yes please list

ATF Form 4 (5320.4)

CLEO Copy

Revised September 2019

Signature of Transferee

Date

Full Name

Full Name

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

ATF Form 4 (5320.4)

CLEO Copy

Revised September 2019