Paperwork Reduction Act Notice

TMs information request Is in eccordanca with the Peperwork Reduction Act of 1980. The information you provide is used in applying to transfer serviceable firearm* taxpaid to person* other then *>ectel taxpayers Qualified to deei in NFA firearms or government entities. Data M used to identify transferor, transferee, end firearm, and to ensure legality for transfer under Federet, State and local law*. The furnitNng of this information is mendatory. (26 U.S.C. 56121

The foMowing information is provided pursuant to Section 3 of the Privacy Act of t974 (5 U.S.C. J562fe)(3)l:

1 AUTHORITY Solicitation of thi* information « made pursuent to the National Fireerm* Act (26 U.S.C. (5612). Diidosure of this informstion by the applicant i* mandatory lor transfer of en NFA fireerm, unless the trensfer is otheiwbe exempt from tax.

2. nmrose. To Insure payment of the tax Impoeed by 26 U.S.C. fSBII; to insure that the trensfer would not be in violation of lew; end to effect registretion of the fireerm,

3 ROUTINC USES. The information wM be used by ATF to meke the determinetione eet forth in psregreph 2. In addition, to effect registration of the firearm, information as to the identiflcaiion of the firearm, date of registration, snd the Identification and address of person entitled to powen ths fireerm w* be entered Into the National firearms Registration snd Transfer Record. No informer ion obtained from sn eppNcation. registration, or records required to be submitted by a natural person in order to comply with eny provision of the Netionei Fireerm* Act or regulationa issued thereunder, tfte*, except in connection with prosecution or ether action for furnishing false information, be used, directly or indirectly, es evidence against that person in any criminal proceeding with respect to a violation of lew occurring prior to or concurrently with the !*ng of the application. The information from this application may only be diecloeed to Federal authorities for purposes of prosecution for violation of the National Fireerms Act,

4. iffgCTS OF NOT SVPPL YING INFORMA TION BCOUCSTtD. Feilurs to supply complete informetion wff delay proceaalng and may cause denial of the application.

fowi Apprend: OMB Ne «12-0027 l»»/ii/Wi

DEPARTMENT OF THE TREASURY BUREAU OF ALCOHOL, TOBACCO ANO FIREARMS APPLICATION FOR TAX PAID TRANSFER AND REGISTRATION OF FIREARM

SEE INSTRUCTIONS ATTACHED. TO BE SUBMITTED IN DUPLICATE TO: National Firearma Act Branch

2a. TRANSFEREE'S NAME ANO ADDRESS (Il traniferee a ■ Special (Occupational) To it acquiring firearm for personaf use, rather than a* part of hit business inventory. «h nam* below and check here: U)

Bayer who 9W personal

Bureau of Alcohol. Tobacco and

Firearma P.O. Box 73201 Chicago, IL 80673-7201

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