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1. Type of Application (check one)
a. Tax Paid. Submit with your application a
check or money order for $200 made payable
to the Department of the Justice. Upon
approval of the application, this office will
acquire, affix, and cancel the required
“National Firearms Act: stamp for you.
b. Tax Exempt because firearm is being made
on behalf of the United States, or any
department, independent establishment, or
c. Tax Exempt because firearm is being made by
or on behalf of any State or possession of the
United States, or any political subdivison
thereof, or any official police organization of
such a government entity engaged in criminal
OMB No. 1140-0011 (10/31/2013)
To: National Firearms Act Branch, Bureau of Alcohol, Tobacco, Firearms and Explosives, 244 Needy Road, Suite 1250, Martinsburg, WV 25405
The undersigned hereby makes application, as required by Sections 5821 and 5822 of the National Firearms Act,
Title 26 U.S.C., Chapter 53, to make and register the firearm described below.
2.Application is made by:
Corporation or Other
3a. Trade Name (If any)
3b. Applicant’s Name and Mailing Address (Type or print below and between the dots)
3c. If P.O. Box is Shown Above, Street Address Must Be Given Here
3e. Telephone Area Code and Number
4. Description of Firearm (complete items a through i)
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