Application To Make Ano Register A Firearm

iüuhntit in JupfH-ite Siv MtmnrtKtrtt ttItched !

3a. APPLICANT'S NAME ANO MAILING AOORESS <Tx*

TYPE OF APPLICATION H'tnii ,,ar) ] ». TAX PAIO. Submit wtth your applies' t&ttck o> mo"rv otott tor SSOOmttot iM lo the Department of the TrrtfXV approval of (f>C application thitol'KCW ecduire, *<*•>. <«4 caned the required "Natiunal Firearm« Act" stamp fUr y ou J b. TAX EXEMPT becaute firearm it bein mad« on 0 •*>(<< ol the Uniied S tatet, or i department, independent ettsbiithmem.

agency thereof 1 c TAX EXEMPT became firearm itbem made by or on behalf ol any State or poi non of the United State*, or any politic» fubdivwon thereof, or any oficia* pol in

. IF P 0. SOX IS SHOWN ABOVE, STREET AOORESS MUST BE GIVEN HERE

. TELEPHONE AREA COOE ANO NUMBfcH

DESCRIPTION OF FIREARM (Complet» item i through >1

NAME ANO LOCATION OF ORIGINAL MANUFACTURER OF FIREARM (RECEIVER) tit prototype, furnish plant and tpedflcmtioñl) (Ser hflhirAn If. I

b TYPE OF FIREARM TO BE MADE '»»rrfterreted rifle. merftinr inn. drlinicNif

.CALIBER. GAUGE OR SIZE tSpn.il

9- SERIAL NUMBER tSrr Initewctwm ig l

S. APPLICANT S FEOERAL FIREARMS LICENSE lift*,,

6. SPECIAL (OCCUPATIONAL) TAX STATUS

(Clvt compute IS-dtnlt ntmlttff

. ATF iOENTIFCATtON NUfctR

7. EMPLOYER'S IOFNTIF (CATION NUMBER ftf «»ft«»*/

IMPORTANT- GIVE FULL PET Al LS ON SEPARATE SHEET FOR ALL "VES" ANSWERS IN (TEMS B ANO 9

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