Form Fd 4542A – Fill Out and Use This PDF

CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

FIREARM OWNERSHIP RECORD

Processing Fee of $19 Per Firearm Must Accompany Application

INSTRUCTIONS ON REVERSE

A. Owner Information

U.S.

YES

If no, enter

AND Country

CITIZEN?

NO

AR# or I-94#

of Citizenship

Enter your California Driver's License (CDL), California ID (CID), or Military ID (MIL)

ID TYPE (Circle One)

ID NUMBER

number in the ID Number box to the right. If using your military identification you must

CDL

CID

MIL

send a copy of your permanent duty station orders stating you are stationed in California.

B. Firearm(s) Information

	Long Gun	If Long	Rifle	If	Semiauto		Single Shot	SERIAL NUMBER
	Handgun	Gun:	Shotgun	Handgun:	Revolver		Other:
MAKE (As stamped on firearm)			MODEL (3032 Tomcat, KP95, 17C, etc.)			CALIBER	FIREARM ORIGIN (U.S., Italy, China, etc.)		BARREL LENGTH
									IN.
									CM.
DATE ACQUIRED			ACQUIRED FROM:		Firearms Dealer		Private Party	Gun Show	COLOR
			Family Member
							Other:
Mo	Day	Yr	(Specify relationship)
	Long Gun	If Long	Rifle	If	Semiauto		Single Shot	SERIAL NUMBER
	Handgun	Gun:	Shotgun	Handgun:	Revolver		Other:
MAKE (As stamped on firearm)			MODEL (3032 Tomcat, KP95, 17C, etc.)			CALIBER	FIREARM ORIGIN (U.S., Italy, China, etc.)		BARREL LENGTH
									IN.
									CM.
DATE ACQUIRED			ACQUIRED FROM:		Firearms Dealer		Private Party	Gun Show	COLOR
			Family Member				Other:
Mo	Day	Yr	(Specify relationship)
	Long Gun	If Long	Rifle	If	Semiauto		Single Shot	SERIAL NUMBER
	Handgun	Gun:	Shotgun	Handgun:	Revolver		Other:
MAKE (As stamped on firearm)			MODEL (3032 Tomcat, KP95, 17C, etc.)			CALIBER	FIREARM ORIGIN (U.S., Italy, China, etc.)		BARREL LENGTH
									IN.
									CM.
DATE ACQUIRED			ACQUIRED FROM:		Firearms Dealer		Private Party	Gun Show	COLOR
			Family Member
							Other:
Mo	Day	Yr	(Specify relationship)

C. Declaration

I declare under penalty of perjury (Sections 126 and 672 PC) that all statements made by me on this application are true and complete. I expressly authorize DOJ to perform firearms eligibility checks of all relevant state and federal databases, including the National Instant Criminal Background Check System. I also understand that if I currently possess/own firearms and the results of this check reveal that I am ineligible either to lawfully possess or purchase firearms, I must relinquish any and all firearms in my possession.

SIGNATURE

DATE

INSTRUCTIONS ON REVERSE

FD 4542A (10/04)

California Department of Justice

Bureau of Firearms

INSTRUCTIONS FOR FIREARM OWNERSHIP RECORD

Firearm Ownership Record Submission Requirements

Individuals must submit this application with a fee (check or money order made payable to the Department of Justice) in the amount of $19 per firearm (i.e. 3 firearms x $19 = $57) to:

Department of Justice

Bureau of Firearms - FOR

P.O. Box 820200

Sacramento, CA 94203-0200

Complete all required information. Incomplete applications or applications submitted without the proper fees will be returned without processing. If reporting more than three firearms, make and attach extra copies of this form to meet your reporting needs. A firearms eligibility check will be conducted to determine whether you are lawfully eligible to possess firearms. Once approved, you will receive a confirmation notice of your Firearms Ownership Record.

This form may not be used to report ownership of assault weapons defined in PC section 12276, 12276.1, or 12276.5. It is the responsibility of the applicant to determine if the firearm being reported is an assault weapon. A list of assault weapons is available on the Firearms Division web site at www.ag.ca.gov/firearms. Questions may be directed to the Bureau of Firearms at (916) 263-4887.

Part A. Owner Information

Enter the information requested. Only one applicant per form. If using a military number for identification you must submit a copy of your permanent duty station orders indicating you are stationed in California.

Part B. Firearm Information

For each firearm, you must provide the identification information requested. Please refer to your firearm owner information or the samples below to assist you in providing the required information:

Serial Number	Usually located on the frame of the handgun, and on the receiver of a long gun. May be
	all numeric or a combination of alpha and numeric characters.
Make	The manufacturer of the firearm (e.g., Beretta, Ruger, Glock, Smith and Wesson).
Model	The model name of the firearm (e.g., 3032 Tomcat, KP95, 17C, Mini 14).
Caliber	The caliber of the firearm (e.g., .38, .45, .308).
Firearm Origin	The country of origin of the firearm (e.g., United States, Russia, China, Italy).
Barrel Length	Enter the barrel length as stated in your owner information, or measure the barrel length
	by closing the action of the firearm and inserting a wooden dowel down the barrel until it
	stops. Mark the dowel with a pen at the muzzle. Remove the dowel and measure the
	distance between the inserted end of the dowel and the pen mark.

Part C. Declaration

You must sign and date the application.