Transferee's / Buyer's Full Name

Current Residence Address
(U.S. Postal abbreviations are acceptable. Cannot be a post office box.)

Permanent Duty Station
Residence Address

Place of Birth

Personal Information

(In addition to ethnicity, select one or more race below. Both must be answered.)

Questionnaire

11a Are you the actual transferee/buyer of the firearm(s) listed on this form? Warning: You are not the actual transferee/buyer if you are acquiring the firearm(s) on behalf of another person. If you are not the actual transferee/buyer, the licensee cannot transfer the firearm(s) to you. Exception: If you are picking up a repaired firearm(s) for another person, you are not required to answer 11.a. and may proceed to question 11.b.
(See Instructions for Question 11.a.)
11b Are you under indictment or information in any court for a felony, or any other crime for which the judge could imprison you for more than one year?
(See Instructions for Question 11.b.)
11c Have you ever been convicted in any court of 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 Instructions for Question 11.b.)
11d Are you a fugitive from justice?
(See Instructions for Question 11.d.)
11e 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.
11f Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution?
(See Instructions for Question 11.f.)
11g Have you been discharged from the Armed Forces under dishonorable conditions?
11h 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 Instructions for Question 11.h.)
11i Have you ever been convicted in any court of a misdemeanor crime of domestic violence?
(See Instructions for Question 11.i.)

Citizenship Status

(Check / List more than one, if applicable. Nationals of the United States may check U.S.A.)
12b Have you ever renounced your United States citizenship?
12c Are you an alien illegally or unlawfully in the United States?
12d.1 Are you an alien who has been admitted to the United States under a nonimmigrant visa?
(See Instructions for Question 12.d.)
12d.2 If "yes" above, do you fall within any of the exceptions stated in the instructions ?

Confirm and Agree

If you want to review your answers, click the REVIEW button, otherwise sign the form and then click I AGREE. By doing so, you are certifying that:
My answers in Section A are true, correct, and complete. I have read and understand the Notices, Instructions, and Definitions on ATF Form 4473. I understand that answering "yes" to question 11.a. if I am not the actual transferee/buyer is a crime punishable as a felony under Federal law, and may also violate State and/or local law. I understand that a person who answers "yes" to any of the questions 11.b. through 11.i and/or 12.b. through 12.c. is prohibited from purchasing or receiving a firearm. I understand that a person who answers "yes" to question 12.d.1. is prohibited from receiving or possessing a firearm, unless the person answers "yes" to question 12.d.2. and provides the documentation required in 18.c. I also understand that making any false oral or written statement, or exhibiting any false or misrepresented identification with respect to this transaction, is a crime punishable as a felony under Federal law, and may also violate State and/or local law. I further understand that the repetitive purchase of firearms for the purpose of resale for livelihood and profit without a Federal firearms license is a violation of Federal law. (See Instructions for Question 14.)

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