CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS - PDF - PDF by rel15922

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									                                             CALIFORNIA DEPARTMENT OF JUSTICE
                                                   BUREAU OF FIREARMS
                                                        CURIO OR RELIC
                                                       HANDGUN REPORT
                 Processing Fee of $19 Per Handgun Must Accompany Application
A. Owner Information                  Instructions on Reverse
LAST NAME                                                            FIRST NAME                              MIDDLE NAME

ALIAS LAST NAME (If Any)                                              ALIAS FIRST NAME                       ALIAS MIDDLE NAME


RESIDENCE STREET ADDRESS                                                     CITY                                     STATE             ZIP


MAILING ADDRESS (If Different)                                               CITY                                     STATE             ZIP


FFL Number                  EXPIRATION DATE                 Enter your CA Driver's License ID TYPE ID NUMBER                     DAYTIME PHONE #
                                                                                            (Circle One)
                                                            (CDL) or CA ID (CID) number in
                                  Day                       the ID Number box to the right. CDL CID                              (       )
                            Mo                 Yr
                           Yes   If no, enter                                              AND Country
U.S.CITIZEN?
                            No   AR# or I-94#                                              of Citizenship
DATE OF BIRTH                    PLACE OF BIRTH                                SEX    RACE    EYE COLOR HAIR COLOR HEIGHT WEIGHT
Mo        Day         Yr
                                 (State or Country)

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

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

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

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 4100A (10/04)
                                     California Department of Justice
                                           Bureau of Firearms
                                    INSTRUCTIONS FOR CURIO OR
                                      RELIC HANDGUN REPORT


Reporting Requirements

Effective January 1, 1998, State law requires all California federal type “03” firearms licensees (collectors of curios
or relics) who obtain curio or relic handguns while out of state to report such purchases or acquisitions to the
Department of Justice within five days of transporting the handgun(s) into California.

Please use the reporting form on the reverse side. Make extra copies of this reporting form to meet your reporting
needs. Do not use this form to report ownership of long guns. If you would like to voluntarily report ownership of a
long gun, please use the Firearm Ownership Record form available on our web site at www.ag.ca.gov/firearms or
by calling (916) 263-4887.

Please be aware that your failure to comply with this mandated handgun reporting requirement could result in your
criminal prosecution (Penal Code section 12072(g)).

Form Completion Instructions

The completed form(s) must be returned with a $19.00 processing fee for each handgun reported (e.g., 3 hand-
guns x $19 = $57). Payment must be made by check or money order payable to the Department of Justice. Mail
completed form and fees to:

                                               Department of Justice
                                                Bureau of Firearms - C&R
                                                 P. O. Box 820200
                                            Sacramento, CA 94203-0200

If you have questions regarding this reporting requirement, direct questions to (916) 263-4887 or visit the Firearms
Division web site at www.ag.ca.gov/firearms.

								
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