CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS

REPORT OF OPERATION OF LAW OR INTRA-FAMILIAL HANDGUN TRANSACTION

Processing fee of $19 for 1 or more handguns must accompany application Instructions on Reverse
FIRST NAME ALIAS FIRST NAME CITY MIDDLE NAME ALIAS MIDDLE NAME STATE ZIP

A. Owner Information
LAST NAME ALIAS LAST NAME (If Any) RESIDENCE STREET ADDRESS MAILING ADDRESS (If Different) DATE OF BIRTH
Mo Day Yr

CITY SEX

STATE

ZIP

PLACE OF BIRTH (State or Country) If no, enter AR# or I-94# AND Country of Citizenship

DAYTIME PHONE #

U.S. CITIZEN?

YES NO

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

ID NUMBER

B. Handgun(s) Information
Type of Handgun: SERIAL NUMBER Semiauto Revolver Single Shot Other: CALIBER HANDGUN ORIGIN
(U.S., Italy, China, etc.)

MAKE (As stamped on firearm)

MODEL (3032 Tomcat, KP95, 17C, etc.)

BARREL LENGTH IN. CM. COLOR

DATE ACQUIRED
Mo Day Yr

ACQUIRED FROM:

HOW POSSESSION WAS OBTAINED:

Type of Semiauto Handgun: MAKE (As stamped on firearm)

SERIAL NUMBER Revolver Single Shot Other:

(U.S., Italy, China, etc.)

MODEL (3032 Tomcat, KP95, 17C, etc.)

CALIBER HANDGUN ORIGIN

BARREL LENGTH IN. CM. COLOR

DATE ACQUIRED
Mo Day Yr

ACQUIRED FROM:

HOW POSSESSION WAS OBTAINED:

Type of Semiauto Handgun: MAKE (As stamped on firearm)

SERIAL NUMBER Revolver Single Shot Other: CALIBER HANDGUN ORIGIN

(U.S., Italy, China, etc.)

MODEL (3032 Tomcat, KP95, 17C, etc.)

DATE ACQUIRED
Mo Day Yr

ACQUIRED FROM:

HOW POSSESSION WAS OBTAINED:

BARREL LENGTH IN. CM. COLOR

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 FD 4544A (10/04)

INSTRUCTIONS ON REVERSE

DATE

California Department of Justice Bureau of Firearms

INSTRUCTIONS FOR REPORT OF OPERATION OF LAW OR INTRA-FAMILIAL HANDGUN TRANSACTION
Submission Requirements
Individuals must submit this application with a fee of $19 in the form of a check or money order made payable to the Department of Justice, for 1 or more handguns, to: Department of Justice Bureau of Firearms - OL P.O. Box 820200 Sacramento, CA 94203-0200 Complete all required information. Incomplete applications will be returned without processing. If reporting more than three handguns, 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 transaction. Do not report long guns using this form. If you wish to voluntarily report ownership of long guns, use the Department of Justice Firearm Ownership Report form available at www.ag.ca.gov/firearms, or by calling (916) 263-4887. 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 website at www.ag.ca.gov/firearms.

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. Handgun Information

For each handgun, you must provide the identification information requested. Please refer to your handgun owner information or the samples below to assist you in providing the required information: Serial Number Usually located on the frame of the handgun. May be all numeric or a combination of alpha and numeric characters. The manufacturer of the handgun (e.g., Beretta, Ruger, Glock, Smith and Wesson). The model name of the handgun (e.g., 3032 Tomcat, KP95, 17C, Mini 14). The caliber of the handgun (e.g., .38, .45, .308). The country of origin of the handgun (e.g., United States, Russia, China, Italy). Enter the barrel length as stated in your owner information, or measure the barrel length by closing the action of the handgun 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. Enter the name of the person from whom you obtained possession of the handgun. Enter the condition under which you obtained the handgun (i.e. as an executor of an estate, as a trustee in bankruptcy, as a secured creditor).

Make Model Caliber Handgun Origin Barrel Length

Acquired From How Possession was Obtained

Part C. Declaration
You must sign and date the application.