U.S. Department of JusticeBureau of Alcohol, Tobacco, Firearms and Explosives Application for Federal Firearms License

OMB No. 1140-0018

Part A

2. Applicant Name (Enter name of Owner/Sole Proprietor OR Partnership (include name of each partner) OR Corporation Name OR LLC Name)

3. Trade or Business Name(s), if any 4. EmployerIdentificationNumber(EIN),ifany(seedefinition#17)

6. Business/Activity Address (RFD or Street Number, City, State,and ZIP Code) (NOTE: This address CANNOT be a P.O. Box.)

7. Mailing Address (ifdifferentfromaddressinitem#6)

8. Contact Numbers (Include Area Code)

9. Describethespecificactivityapplicantisengagedinorintendstoengagein,whichrequiresaFederalFirearmsLicense (sale of ammunitionalone does not require a Federal Firearms License).

10. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an “X” in the appropriate box(es). Multiple license types may be selected- see instruction#8.Submitthefeenotednexttothebox(es)withtheapplication.Licensesareissuedfora3-yearperiod.Seeinstruction#5forpaymentinformation).

Type DescriptionofLicenseType FeeDealer in Firearms Other than Destructive Devices (Includes: rifles,shotguns,pistols,revolvers,gunsmithactivities,andNationalFirearmsAct(NFA)weapons)(seeinstruction#10) $200

06

01

Manufacturer of Ammunition for Firearms Other Than Ammunition for Destructive Devices or Armor Piercing Ammunition (seeinstruction#11)

Manufacturer of Firearms Other than Destructive Devices(seeinstruction#11)

Importer of Firearms Other than Destructive Devices or Ammunition for Firearms Other than Destructive Devices, or Ammunition Other than Armor Piercing Ammunition(NOTE:Importerofhandgunsandrifles,seeinstruction#9)

Dealer in Destructive Devices (seedefinition#20)

Manufacturer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition(seeinstruction#11)

07

08

09

10

$30

$150

$150

$3000

$3000

5. Name of CountyinwhichBusiness/ActivityisLocated

Business/Activity PhoneCell Phone

Fax NumberBusiness Email

CorporationCollector (whichcanbeanindividual/partnership/corporationorLLC) Other (specify)

Importer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition (see instruction#9)11 $3000

Total Fees

1. Applicant’s Business/Activity is:

11. Method of Payment (Check one)

Name as Printed on Your Credit/Debit CardCredit/Debit Card Number (No dashes)

Credit/Debit Card Billing Address:

Visa Mastercard American Express Discover

Address:

City: State: ZIP Code:

Please complete to ensure payment is credited to the correct application:IampayingtheapplicationfeeforthefollowingPerson,Corporation,orPartnership: Total Application Fees:

Signature of Cardholder

IauthorizeATFtochargemyCredit/DebitCardtheaboveamount.Yourcredit/debitcardwillbechargedtheabovestatedamountuponreceiptofyourapplicationandachargefrom“ATFLicensingFee”willbereflectedonyourcredit/debitcardstatement.IntheeventalicenseisNOTissued,theaboveamountwillbecreditedtothecredit/debitcardnotedabove.

Date

$

Check (Enclosed) Cashier’s Check or Money Order (Enclosed)

PawnbrokerinFirearmsOtherthanDestructiveDevices (Includes: rifles,shotguns,pistols,revolvers,gunsmithactivities,andNationalFirearmsAct(NFA)weapons)(seeinstruction#10) $20002

Collector of Curios and Relics (NOTE:Thisisnotalicensetoconductbusiness,seeinstruction#8) $3003

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

IndividualOwner(Sole Proprietor) Partnership LLC

Diner’s Club

Expiration Date (MM/YY)

ATF Copy - Page 1

$

20. Applicant Certification (Please read AND INITIAL each box)

12. Hours of Operation and/or Availability of Business/Activity (pleaseprovideatleastonehourinwhichyoucanbecontactedbyATFpersonnel)Sun Mon Tues Wed Thu Fri Sat

Hour(s):Please indicate

AM or PMIF YOU ARE ONLYAPPLYINGFORATYPE03(COLLECTOROFCURIOSANDRELICS)LICENSE,SKIPITEMS13-17ANDGOTOITEM18.

FORALLOTHERLICENSETYPES,CONTINUEWITHITEM13.13. Was the business obtained from someone else? (If “Yes,”

pleaseprovidethenameofthepreviousbusinessandtheirFFL Number)

Name of Previous Business

14. Indicate type of business premisesZoned Commercial:Zoned Residential:

Store FrontOfficeRod&GunClub

SingleFamilyDwellingCondominium/ApartmentHotel/Motel

Military Installation (seeinstruction#13-additionalinformation required)Other (specify)

Public Housing

FederalFirearmsLicenseNumber

OwnedPremises

Rented/LeasedPremises-providename,telephonenumber,andaddressof the property owner:

Military Installation

NoYes

15. Applicant’s business premises is:

Name

Telephone Number (with area code)

Street Address

City, State, and ZIP Code

16. DoyouintendtosellfirearmsatGunShowsand/orconductInternetsales? Yes No

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

17. DoyouintendtouseyourlicenseONLYtoacquirefirearmstoenhanceyourpersonalcollection? Yes No

a. Thebusiness/activitytobeconductedundertheFederalFirearmsLicenseisnotprohibitedbyStateorlocallawatthepremisesshowninitem6.Thisincludescompliancewithzoningordinances. (Please contact your local zoning department PRIOR TO submitting application)

b. Within30daysaftertheapplicationisapproved,thebusiness/activitywillcomplywiththerequirementsofStateandlocallawapplicable to the conduct of the business/activity.

c. Business/activitywillnotbeconductedunderthelicenseuntiltherequirementsofStateandlocallawapplicabletothebusiness/activityhave been met.

d. A completed copy of this application has been sent (mailedordelivered)totheChiefLawEnforcementOfficer(CLEO)ofthelocalityinwhichthepremiseslistedinitem6islocated(seeinstruction#4anddefinition#1).

18. NameofChiefLawEnforcementOfficer(CLEO) (Pleaseprint the name of the CLEO to whom a copy of thisapplicationwasprovided.Seeinstruction#4anddefinition#1.)

19. AddressofCLEO(Include Number, Street, City, County, State, and ZIPCode)

e. Asrequiredby18U.S.C.923(d)(1)(G),IcertifythatsecuregunstorageorsafetydeviceswillbeavailableatanyplaceinwhichfirearmsaresoldunderthisFederalFirearmsLicensetopersonswhoarenotlicensees.(Seedefinition#4)(IfapplyingforaType03,CollectorofCurios and Relics License ONLY,write“N/A”insteadofinitialingthiscertificationbox.)

f. PartBofthisapplicationhasbeencompletedandwillbesubmittedforEACH responsible person (RP) (Seedefinition#3)

21. Certification:Underthepenaltiesimposedby18U.S.C.924,IdeclarethatIhaveexaminedthisapplicationinitsentiretyandthedocumentssubmittedinsupportthereofandtothebestofmyknowledgeandbelief,theyaretrue,correct,andcomplete.Thissignature,whenpresentedbyadulyauthorizedrepresentativeoftheU.S.DepartmentofJustice,willconstituteconsentandauthorityfortheappropriateU.S.Departmentof Justice representative to examine and obtain copies and abstracts of records and to receive statements and information regarding thebackgroundoftheapplicant.Specifically,IherebyauthorizethereleaseofthefollowingdataorrecordstoATF:Militaryinformation/records,medicalinformation/records,policeandcriminalrecords.ThiscertificationmustbesignedbyaResponsiblePerson(seeinstruction#2anddefinition#3).

Print Applicant Name (First, Middle, Last) Applicant Signature Date

ATTENTION Chief Law Enforcement Officer (CLEO): Thisformprovidesnotificationofaperson’sintenttoapplyforaFederalFirearmsLicense(FFL).Itrequiresnoactiononyourpart.However,shouldyouhaveinformationthatmaydisqualifythepersonfromobtainingaFederalFirearmsLicense,pleasecontacttheFederalFirearmsLicensingCentertollfreeat1-866-662-2750.IssuanceofanFFLinnowayguaranteesthebusinessoractivityisnotinviolationofStateand/orlocallaw.

ATF Copy - Page 2

county:

Check Application Status (For ATF Use Only) Abandoned WithdrawnApproved Denied Reason for Denial:

SignatureofLicensingOfficial: Date:

1. LicenseorApplicantName(Fromblock2ofPartA) 2.FederalFirearmsLicenseNumber(IfbeingaddedtoanexistingFFL)

3. Name of Responsible Person (Last, First, Middle) 4. Aliases (Includegiven,married,maidennames)

6. Social Security Number

5. Position/Title

9. Current Residence Address 10. Telephone Number (PersonalContact#withAreaCode)

7. Date of Birth (MM/DD/YYYY) 8. Place of Birth (City & State ORforeigncountry)

13. Sex 14. Height 15. Weight 16. Eye ColorMale

Female

17. Hair Color

Feet

Inches (lbs)BlackBlueBrown

GreenGray

HazelMaroonMultiple

OtherPink

Bald

BlackBlond

GrayBrown

RedSandyWhite

19. Race (Please check one or more boxes)American Indian or Alaska Native

Black or African American

NativeHawaiianorOtherPacificIslanderAsian

HispanicorLatino

White

12. Previous Address(es) - Please provide everyaddressyouhavehadinthelastfiveyearsanddateswhichyoulivedattheaddress(es)(Ifadditional space is needed attach a separatesheet.Seeinstruction#1)

Yes No

20. HaveyoueverheldaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

21. HaveyoueverbeenaResponsiblePersononaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

22. HaveyoueverbeenanofficerinacorporationholdingaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

23. HaveyoueverbeenanemployeeofaFederalFirearmsLicensee?

24. HaveyoueverbeendeniedaFederalFirearmsLicense?

25. HaveyoueverhadaFederalFirearmsLicenserevoked?

26. Areyouunderindictmentorinformationinanycourtforafelony,oranyothercrime,forwhichthejudgecouldimprison you for more than one year? (Seedefinition#10)

27. Haveyoueverbeenconvictedinanycourtforafelony,oranyothercrime,forwhichthejudgecouldhaveimprisonedyouformorethan one year, even if you received a shorter sentence including probation? (Seedefinition#10)

28. Areyouafugitivefromjustice?(Seedefinition#11)

29. Are you under 21 years of age?

30. Areyouanunlawfuluserof,oraddictedto,marijuanaoranydepressant,stimulant,narcoticdrug,oranyothercontrolledsubstance?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.

1. EACH RESPONSIBLE PERSON MUST COMPLETE AND SIGN A SEPARATE QUESTIONNAIRE/ATF Form 7/7CR Part B. In the future, ifyouneedtoaddanadditionalResponsiblePersontoyourFFL,theResponsiblePersonbeingaddedmaycompletethisPartB-ResponsiblePerson Questionnaire (see instruction #7).

2. IssuanceofyourlicenseoradditionasaResponsiblePersonwillbedelayedifPartBisincompleteorotherwiseimproperlyprepared.3. IMPORTANT!AllnewresponsiblepersonsmustsubmitaproperlypreparedFD-258(FingerprintCard)withthisquestionnaire.Thefingerprints

mustbeclearforaccurateclassificationandtakenbysomeoneproperlyequippedtotakethem.TheFD-258shouldinclude“WVATF1100ATF-FFLC,MARTINSBURG,WV”intheORIblocktofacilitateprocessingoffingerprints.

4. Listanygiven,married,andmaidennamesinItem4,e.g.,“MaryAlice(Smith)Jones,”not“Mrs.JohnJones.”(If additional space is needed, attachaseparatesheet.Seeinstruction#1)

For the following questions give full details on a separate sheet for all “Yes” answers(seeinstruction#1)

11. E-mail Address

18. EthnicityYes No

Other

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018ATF Copy - Page 3

31. HaveyoueverbeenadjudicatedasamentaldefectiveOR have you ever been committed to a mental institution?(Seedefinitions#12and#13)

32. Have you been discharged from the Armed Forces under dishonorable conditions?33. Areyousubjecttoacourtorderrestrainingyoufromharassing,stalking,orthreateningyourchildoranintimatepartnerorchildof

such partner?(Seedefinition#5)34. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (Seedefinition#7)

Part B - Responsible Person Questionnaire

Yes No

35. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.)

36. Have you ever renounced United States citizenship?

37. AreyouanalienillegallyorunlawfullyintheUnitedStates?

40. Under the penalties imposed by 18 U.S.C. § 924 and 1001, I declare that I have examined any related documents submitted in regard to thisquestionnaire/ATFForm7/7CRPartB,andtothebestofmyknowledgeandbelief,theyaretrue,correctandcomplete.Thissignature,whenpresentedbyadulyauthorizedrepresentativeoftheU.S.DepartmentofJustice,willconstituteconsentandauthorityfortheappropriateU.S.Department of Justice representative to examine and obtain copies and abstracts of records and to receive statements and information regarding mybackground.Specifically,IherebyauthorizethereleaseofthefollowingdataorrecordstoATF:Militaryinformation/records,medicalinformation/records, police and criminal records.

Signature Printed Name Date

Attach a 2” X 2”Photograph Here

If you are applying for a Type 03 ONLY a photograph is not required

1. Photo must have been takenwithinthelastsixmonths.

2. Photo must have been taken in fullfaceviewwithoutahatorheadcovering that obscures the hair orhairline.

3. On back of photograph print fullname, last 4 of SSN, and businessaddress.

Print Full Name

EACH RESPONSIBLE PERSON MUST COMPLETE AND SIGN A SEPARATE QUESTIONNAIRE/ATF FORM 7/7CR PART B

If applying for a NEW FFL:Mailapplication,fingerprintcards,photographs,andapplicationfees,includinga

separate questionnaire/PartBforEACH Responsible Person, to:

FederalFirearmsLicensingCenterP.O. Box 6200-20

Portland, OR 97228-6200

If only adding a RP to an existing FFL: EachReponsiblePersonbeingaddedmustcompleteaseparatequestionnaire/ATFForm7/7CRPartBandmailit,alongwiththeirfingerprintcardandphotograph,to:ATF,Attn:FFLC,244NeedyRd, Martinsburg, WV 25405

Type 03 Applicants:AphotographandfingerprintcardarenotrequiredifyouareapplyingforaType03 Collector of Curios and Relics license only.

Questions:Ifyouhaveanyquestionsrelatingtothisform,pleasecontacttheATFFederalFirearmsLicensingCenterat1-866-662-2750,oryourlocalATFIndustryOperationsOffice.

38. a.AreyouanalienwhohasbeenadmittedtotheUnitedStatesunderanonimmigrantvisa?(Seedefinition#8)

b. If“yes”,doyoufallwithinanyoftheexceptionsstatedindefinition#9?Attachsupportingdocumentationtotheapplication.

39. If you are an alien, record your U.S.-Issued Alien or Admission number(AR#,USCIS#,orI94#):

Paperwork Reduction Act Notice

ThisrequestisinaccordancewiththePaperworkReductionActof1995.Theinformationcollectionisusedtodeterminetheeligibilityoftheapplicanttoengageincertainoperations,todeterminethelocationandextentofoperations,andtodeterminewhethertheoperationswillbeinconformitywithFederallawsandregulations.Theinformationrequestedisrequiredinordertoobtainorretainabenefitandismandatorybystatute(18U.S.C.§923).

Theestimatedaverageburdenassociatedwiththiscollectionofinformationis60minutesperrespondentorrecordkeeper,dependingonindividualcircumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to Reports ManagementOfficer,ResourceManagementStaff,BureauofAlcohol,Tobacco,FirearmsandExplosives,Washington,DC20226.

Anagencymaynotconductorsponsor,andapersonisnotrequiredtorespondto,acollectionofinformationunlessitdisplaysacurrentlyvalidOMBcontrol number.

ATF Copy - Page 4

N/A

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

United States of America Other Country/Countries (specify):

Instructions/Definitions for ATF Form 7 (5310.12)/7CR (5310.16)(Do not return this sheet when submitting your application)

Issuance of your license will be delayed if the fee is not included or incorrect, or if the application is incomplete or otherwise improperly prepared.

Instructions

1. Completion of Application - TYPEorPRINTwithball-pointpen.Anyattachedsheetsshould:a. beidentifiedatthetopofeachpagewithyournameandEmployerIdentificationNumberorSocialSecurityNumber.b. refertotheitem/question(s)beinganswered.

2. Person Who Signs the Application -ThecertificationinPartA,item#21must be signed by a Responsible Person(seedefinition#3).

3. Release of Information -ThisapplicationpackagerequiresyoutoauthorizethereleaseofcertaininformationtoATFsuchasmedicalinformation/records (seePartA,item#21).Thisinformationisusedtodetermine,forexample,whethertheapplicanthaseverbeenadjudicatedasamentaldefective or committed to any mental institution. This information is protected by the Privacy Act of 1974.

4. Chief Law Enforcement Officer (CLEO) -ApplicantsmustsubmitacopyofthecompletedapplicationtotheChiefLawEnforcementOfficer(CLEO)ofthelocalityinwhichthepremisessoughttobelicensedislocated(seedefinition#1).PartA,item#20drequirescertificationthatacompleted copy of the application has been sent.

5. Payment - You may pay the application fee by credit/debit card, check, or money order, payable to ATF (seeinstruction#14onthefollowingpagefortheaddresstosendpaymentandcompletedapplicationpackage). Do not send cash.Postdatedchecksarenotacceptable.Licensesareissuedforaperiodofthreeyears.Norefundofanypartofalicensefeeshallbemadewheretheoperationsofthelicenseare,foranyreason,discontinuedduring the period.

6. Fingerprint Cards & Photographs - Thefollowingitemsmustaccompanythisapplication.Failuretosubmittheseitemswilldelayprocessingandmay result in denial of the application. NOTE: AfingerprintcardandphotographareNOTrequiredifapplyingforaType03licenseonly.a. ATF Form 7/7CR Part B, Responsible Person Questionnaire, must be completed and submitted for ALL responsible persons(seedefinition#3).b. Aproperlypreparedfingerprintcard(formFD-258)mustbesubmittedforALL responsible persons, unless they have peviously submitted

oneasanRPforanotherFFL.Thefingerprintsmustbeclearforaccurateclassificationandtakenbysomeoneproperlyequippedtotakethem.Tofacilitateprocessingoffingerprints,theFD-258shouldlist“WVATF1100ATF-FFLC,MARTINSBURG,WV”intheORIblock.

c. A 2 inch by 2 inch photograph of EACH responsible person. The photograph should be attached to the back of their ATF Form 7/7CRPart B,ResponsiblePersonQuestionnaire.Pleaseensurethateachphotographisclearlyidentifiedonthereversewiththefullnameoftheresponsiblepersontowhomthephotographapplies.

7. Adding Additional Responsible Persons -YoucanusePartBofthisapplicationtoaddaResponsiblePerson(s)toanexistingFFL.IfyouareonlysubmittingPartBforthispurpose,sendPartB,alongwiththeResponsiblePerson’sfingerprintcardandphotograph,toATF-FFLC,244NeedyRoad,Martinsburg,WV25405.OnlysendtothisaddressifyouarejustaddingaResponsiblePerson(s)toanexistinglicense.SendinganapplicationtoobtainanewFFLtothisaddresswillresultindelaysintheprocessingofyourapplication.

8. License Types -A Type 03 license issued under 18 U.S.C. Chapter 44:a. Is NOTalicensetocarry,use,orpossessafirearm.b. Confers NOrightorprivilegetoconductanactivitycontrarytoStateorotherlaw.c. Willentitleyoutoacquirefirearms,classifiedascuriosorrelics,ininterstateorforeigncommerce.Youmaydisposeofcuriosandrelicsto

anyperson,nototherwiseprohibitedbytheGunControlActof1968,residingwithinyourState,andtoanyotherFederalfirearmslicenseeinanyState.Itmustbeemphasizedthatthecollector’slicensebeingappliedforpertainsexclusivelytofirearmsclassifiedascuriosandrelics,and its purpose is to facilitate a personal collection. You may NOT engage in the businessofbuyingandsellinganytypeoffirearmwithatype03license.ApplicantsintendingtoengageinthefirearmsbusinessshouldapplyforalicenseotherthanaType03,CollectorofCuriosandRelics, license.

Type 01, 02, 06, 07, 08, 09, 10, and 11 licenses issued under 18 U.S.C. Chapter 44:a. Are NOTlicensestocarry,use,orpossessafirearm.b. Confer NOrightorprivilegetoconductbusinessoractivitycontrarytoStateorotherlaw.Statelawsorlocallawsorordinancesmayhave

requirementsaffectingyourproposedfirearmsbusiness.ContactyourStateandlocalauthoritiesforspecificinformationontheirrequirements.c. Arebusinesslicenses,andwillNOTbeissuedtoanapplicantsolelyintendingtoenhanceapersonalfirearmscollection.d. Are NOT licenses to sell ammunition only.

NOTE: Multiple Licenses - You can apply for more than one license if the business is to be conducted at the same location, by checking more thanonetypeoflicenseinPartA,item#10.Ifbusinessistobeconductedatmultiplelocations,a separate application and license fee is required for each business location.

9. Imports - Applicantsintendingtoimportfirearmsand/orammunitionmayneedtoregisterwithATFundertheprovisionsoftheArmsExportControl Act. Contact the Firearms and Explosives Imports Branch at (304) 616-4550 for further information on registration.

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

10. National Firearms Act (NFA)/Special Occupational Tax (SOT) -Applicantsintendingtodealin,import,ormanufactureweaponssubjecttotheNFA (e.g.,machineguns,short-barreledshotguns,silencers,destructivedevices,etc.)arerequiredtopayaSOT(seedefinition#18). Contact theNFA Branch at (304) 616-4500.

11. Manufacturing - Generally,personsholdingamanufacturer’slicense(FFLType06,07or10)mustregisterasamanufacturerwiththeDepartmentofStateunlessexemptedbytheDirectorateofDefenseTradeControl(DDTC),regardlessofwhetherthemanufactureractuallyexportsanyoftheitemsmanufactured.Therefore,applicantsintendingtomanufactureand/orexportdefensearticles,asdefinedontheUnitedStatesMunitionsList(Part121oftheITAR),mayneedtoregisterwithDirectorateofDefenseTradeControls(DDTC).QuestionsshouldbedirectedtotheDDTCat 202-663-2980 or www.pmddtc.state.gov.

12. Denial of Application - Ifyoudonotqualifyforalicense,youwillbeadvisedinwritingofthereasonsfordenialandyourapplicationfeewillberefunded.

13. Military Installation - If“MilitaryInstallation”wasselectedinPartA,item#14asthetypeofbusinesspremises,youmustattachacopyofwrittenauthorizationfromtheBaseCommandertoconductafirearmsbusinessonthemilitaryinstallation.

14. Where to Send Application -MAKEACOPYOFYOURCOMPLETEDAPPLICATIONFORYOURRECORDS,THENFORWARDTHEAPPLICATIONWITHFEE,ONEATFFORM7/7CRPARTB,RESPONSIBLEPERSONQUESTIONNAIRE,FOREACHRESPONSIBLEPERSON(WITHPROPERLYIDENTIFIEDPHOTOATTACHED),ANDFINGERPRINTCARD(S)TO:

Federal Firearms Licensing Center P.O. Box 6200-20

Portland, OR 97228-6200

15. Contact Us - Ifyouhaveanyquestionsrelatingtothisapplication,pleasecontacttheATFFederalFirearmsLicensingCenter,244NeedyRoad,Martinsburg,WV25405,Tollfree1-866-662-2750,oryourlocalATFIndustryOperationsOffice.Contactinformationforyourlocalofficecanbefound at WWW.ATF.GOV.

Definitions

1. Chief Law Enforcement Officer-TheChiefofPolice,Sheriff,oranequivalentdesigneeofsuchindividual,ofthelocalityinwhichthepremisessought to be licensed, is located.

2. Licensed Collector - A collector of curios and relics only and licensed under the provisions of 18 U.S.C. 923. You may not use the license to obtainfirearmsthatarenotclassifiedascuriosandrelics.Collectorsarenot licensed to conduct any business.

3. Responsible Person - In addition to a Sole Proprietor, a Responsible Person is, in the case of a Corporation, Partnership, or Association, anyindividualpossessing,directlyorindirectly,thepowertodirectorcausethedirectionofthemanagement,policies,andpracticesoftheCorpora-

tion,Partnership,orAssociation,insofarastheypertaintofirearms.

4. Secure Gun Storage or Safety Device-(A)adevicethat,wheninstalledonafirearm,isdesignedtopreventthefirearmfrombeingoperatedwithoutfirstdeactivatingthedevice;(B)adeviceincorporatedintothedesignofthefirearmthatisdesignedtopreventtheoperationofthefirearmbyanyonenothavingaccesstothedevice;or(C)asafe,gunsafe,guncase,lockbox,orotherdevicethatisdesignedtobeorcanbeusedtostoreafirearmandthatisdesignedtobeunlockedonlybymeansofakey,acombination,orothersimilarmeans.

5. Restraining Order-Under18U.S.C.§922(g)(8),firearmsmaynotbepossessedorreceivedbypersonssubjecttoacourtorderthat:(A)wasissuedafterahearingofwhichthepersonreceivedactualnoticeandhadanopportunitytoparticipatein;(B)restrainssuchpersonfromharassing,stalking,orthreateninganintimatepartnerorchildofsuchintimatepartnerorperson,orengaginginotherconductthatwouldplaceanintimatepartnerinreasonablefearofbodilyinjurytothepartnerorchild;and(C)(i)includesafindingthatsuchpersonrepresentsacrediblethreattothephysical safety of such intimate partner or child, or (ii) by its terms explicitly prohibits the use, attempted use, or threatened use of physical forceagainstsuchintimatepartnerorchildthatwouldreasonablybeexpectedtocausebodilyinjury.

6. Intimate Partner-Withrespecttoaperson,thespouseoftheperson,aformerspouseoftheperson,anindividualwhoisaparentofachildoftheperson,oranindividualwhocohabitatesorhascohabitatedwiththeperson.

7. Misdemeanor Crime of Domestic Violence-AFederal,State,local,ortribaloffensethatisamisdemeanorunderFederal,State,ortriballawandhas,asanelement,theuseorattempteduseofphysicalforce,orthethreateneduseofadeadlyweapon,committedbyacurrentorformerspouse,parent,orguardianofthevictim,byapersonwithwhomthevictimsharesachildincommon,byapersoncohabitatingwith,orhascohabitatedwiththe victim as a spouse, parent, or guardian, or by a person similarly situated to a spouse, parent, or guardian of the victim. The term includes allmisdemeanorsthathaveasanelementtheuseorattempteduseofphysicalforceorthethreateneduseofadeadlyweapon(e.g.,assaultand

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

battery),iftheoffenseiscommittedbyoneofthedefinedparties.(SeeExceptioninthedefinitionof“ProhibitedPerson”).Apersonwhohasbeenconvictedofamisdemeanorcrimeofdomesticviolencealsoisnotprohibitedunless;(1)thepersonwasrepresentedbyalawyerorgaveuptherighttoalawyer;or(2)ifthepersonwasentitledtoajury,wastriedbyajury,orgaveuptherighttoajurytrial.Personssubjecttothisexceptionshouldmark“no”intheapplicablebox.

8. An Alien Admitted to the United States Under a Nonimmigrant Visa - Includes, among others, persons visiting the United States temporarily for business or pleasure,personsstudyingintheUnitedStateswhomaintainaresidenceabroad,andcertaintemporaryforeignworkers.ThedefinitiondoesNOT includepermanent resident aliens nor does it apply to nonimmigrant aliens admitted to the United States pursuant to either the Visa Waiver Program or to regulations otherwiseexemptingthemfromvisarequirements.

9. Exceptions to Prohibition on Aliens Admitted Under a Nonimmigrant Visa - An alien admitted to the United States under a nonimmigrant visaisnotprohibitedfrompurchasing,receiving,orpossessingafirearmifthealien:(1)isinpossessionofahuntinglicenseorpermitlawfullyissuedbytheFederalGovernment,aState,orlocalgovernment,oranIndiantribefederallyrecognizedbytheBureauofIndianAffairs,whichisvalidandunexpired;(2)wasadmittedtotheUnitedStatesforlawfulhuntingorsportingpurposes;(3)hasreceivedawaiverfromtheprohibitionfromtheAttorneyGeneraloftheUnitedStates;(4)isanofficialrepresentativeofaforeigngovernmentwhoisaccreditedtotheUnitedStatesGovernmentortheGovernment’smissiontoaninternationalorganizationhavingitsheadquartersintheUnitedStates;(5)isenroutetoorfromanothercountrytowhichthatalienisaccredited;(6)isanofficialofaforeigngovernmentoradistinguishedforeignvisitorwhohasbeensodesignatedbytheDepartmentofState;or(7)isaforeignlawenforcementofficerofafriendlyforeigngovernmententeringtheUnitedStatesonofficiallawenforcement business.

10. Prohibited Person - Generally,18.U.S.C.§922(g)prohibitstheshipment,transportation,receipt,orpossessioninoraffectinginterstatecommerceofafirearmbyonewho:hasbeenconvictedofamisdemeanorcrimeofdomesticviolence;hasbeenconvictedofafelony,oranyothercrime,punishable by imprisonment for a term exceeding one year (this does not include State misdemeanors punishable by imprisonment of two years orless);isafugitivefromjustice,isanunlawfuluserof,oraddictedto,marijuanaoranydepressant,stimulant,ornarcoticdrug,oranyothercontrolledsubstance;hasbeenadjudicatedasamentaldefectiveorhasbeencommittedtoamentalinstitution;hasbeendischargedfromtheArmedForcesunderdishonorableconditions,hasrenouncedhisorherU.S.citizenship;isanalienillegallyintheUnitedStatesoranalienadmittedtotheUnitedStatesunderanonimmigrantvisa;orissubjecttocertainrestrainingorders.Furthermore,Section922(n)prohibitstheshipment,transportation,orreceiptinoraffectinginterstatecommerceofafirearmbyonewhoisunderindictmentorinformationforafelonyinanyFederal,Stateorlocalcourt,oranyothercrime,punishablebyimprisonmentforatermexceedingoneyear.Aninformationisaformalaccusationofacrimeverifiedbyaprosecutor.

EXCEPTION: Apersonwhohasbeenconvictedofafelony,oranyothercrime,forwhichthejudgecouldhaveimprisonedthepersonformorethanoneyear,orwhohasbeenconvictedofamisdemeanorcrimeofdomesticviolence,isnotprohibitedfrompurchasing,receiving,orpossessingafirearmif:(1)underthelawofthejurisdictionwheretheconvictionoccurred,thepersonhasbeenpardoned,theconvictionhasbeenexpungedorset aside, or the person has had their civil rights (therighttovote,sitonajury,andholdpublicoffice)takenawayandlaterrestoredAND(2)thepersonisnotprohibitedbythelawofthejurisdictionwheretheconvictionoccurredfromreceivingorpossessingfirearms.Personssubjecttothisexceptionshouldmark“no”intheapplicablebox.

11. Fugitive From Justice - AnypersonwhohasfledfromanyStatetoavoidprosecutionforafelonyoramisdemeanor,oranypersonwholeavestheStatetoavoidgivingtestimonyinanycriminalproceeding.ThetermalsoincludesanypersonwhoknowsthatmisdemeanororfelonychargesarependingagainstsuchpersonandwholeavestheStateofprosecution.

12. Adjudicated as a Mental Defective - Adeterminationbyacourt,board,commission,orotherlawfulauthoritythataperson,asaresultofmarkedsubnormalintelligence,ormentalillness,incompetency,condition,ordisease:(1)isadangertohimselfortoothers;or(2)lacksthementalcapacitytocontractormanagehisownaffairs.Thistermshallinclude:(1)afindingofinsanitybyacourtinacriminalcase;and(2)those persons found incompetent to stand trial or found not guilty by reason of lack of mental responsibility.

13. Committed to a Mental Institution - Aformalcommitmentofapersontoamentalinstitutionbyacourt,board,commission,orotherlawfulauthority. The term includes a commitment to a mental institution involuntarily. The term includes commitment for mental defectiveness or mentalillness. It also includes commitments for other reasons, such as for drug use. The term does not include a person in a mental institution forobservation or a voluntary admission to a mental institution.

EXCEPTION: UndertheNICSImprovementAmendmentsActof2007,apersonwhohasbeenadjudicatedasamentaldefectiveorcommittedtoamentalinstitutioninaStateproceedingisnotprohibitedbytheadjudicationorcommitmentifthepersonhasbeengrantedreliefbytheadjudicating/committingStatepursuanttoaqualifyingmentalhealthrelieffromdisabilitiesprogram.Also,apersonwhohasbeenadjudicatedasamentaldefectiveorcommittedtoamentalinstitutionbyadepartmentoragencyoftheFederalGovernmentisnotprohibitedbytheadjudicationorcommitmentifeither:(a)theperson’sadjudicationorcommitmentwasset-asideorexpungedbytheadjudicating/committingagency;(b)thepersonhasbeenfullyreleasedordischargedfromallmandatorytreatment,supervision,ormonitoringbytheagency;(c)thepersonwasfoundbytheagencytonolongersufferfromthementalhealthconditionthatservedasthebasisoftheinitialadjudication/commitment;(d)theadjudicationorcommitment,respectively,isbasedsolelyonamedicalfindingofdisability,withoutanopportunityforahearingbyacourt,board,commission,orotherlawfulauthority,andthepersonhasnotbeenadjudicatedasamentaldefectiveconsistentwithsection922(g)(4)oftitle18,UnitedStatesCode;or(e)thepersonwasgrantedrelieffromtheadjudicating/committingagencypursuanttoaqualifiedmentalhealthrelieffromdisabilities program. Personswhofallwithinoneoftheaboveexceptionsshouldmark“no”intheapplicablebox.Thisexceptiontoanadjudicationor commitment by a Federal department or agency does notapplytoanypersonwhowasadjudicatedtobenotguiltybyreasonofinsanity,orbasedon a lack of mental responsibility, or found incompetent to stand trial, in any criminal case or under the Uniform Code of Military Justice.

Privacy Act Information

ThefollowinginformationisprovidedpursuanttoSection3ofthePrivacyActof1974(5U.S.C.§552a(e)(3)):

1. Authority:Solicitationofthisinformationisauthorizedpursuantto18U.S.C.§923(a)oftheGunControlActof1968.DisclosureofthisinformationismandatoryiftheapplicantwishestoobtainaFederalFirearmsLicense.SystemofRecordNotice(SORN)Justice/ATF-008Regulatory Enforcement Record System FR Vol. 68 No. 163558 dated January 24, 2003.

2. Purpose:TodeterminetheidentityandeligibilityoftheapplicanttoobtainaFederalFirearmsLicense,theidentityandeligibilityofallresponsiblepersons,theownershipofthebusiness,thetypeoffirearmsorammunitiontobedealtin,thebusinesshours,andthebusinesshistory.

3. Routine Uses:TheinformationwillbeusedbyATFtomakedeterminationssetforthinparagraph2.Inaddition,informationmaybedisclosedtootherFederal,State,foreignandlocallawenforcementandregulatoryagencypersonneltoverifyinformationontheapplicationandtoaidintheperformanceoftheirdutieswithrespecttotheenforcementandregulationoffirearmsand/orammunitionwheresuchdisclosureisnotprohibitedbylaw.TheinformationmayfurtherbedisclosedtotheJusticeDepartmentifitappearsthatthefurnishingoffalseinformationmayconstituteaviolationofFederallaw.Finally,theinformationmaybedisclosedtomembersofthepublicinordertoverifytheinformationontheapplicationwhensuchdisclosureisnotprohibitedbylaw.

4. Effects of Not Supplying Information Requested:Failuretosupplycompleteinformationwilldelayprocessingandmayresultindenialoftheapplication.

14. Gun Control Act (GCA) - Title 18, United States Code, Chapter 44. The implementing regulations are found in Title 27, Code of FederalRegulations, Part 478.

15. Firearm - Theterm“firearm”means:(A)anyweapon(includingastartergun)whichwillorisdesignedtoormayreadilybeconvertedtoexpelaprojectilebytheactionofanexplosive;(B)theframeorreceiverofanysuchweapon;(C)anyfirearmmufflerorfirearmsilencer;or(D)anydestructivedevice.Suchtermdoesnotincludeanantiquefirearm.

16. Federal Firearms License (FFL) - AlicenseissuedundertheprovisionsoftheGCAtomanufacture,import,ordealinfirearms.

17. Employer Identification Number (EIN) - AnEINisalsoknownasaFederalTaxIdentificationNumber,andisusedtoidentifyabusinessentity.Generally,businessesneedanEIN.FormoreinformationonwhoneedsanEINandhowtoapplyforone,gotowww.IRS.govorreferto27CFR§179.35.

18. Special (Occupational) Tax (SOT) - RequiredbytheNationalFirermsActtobepaidbyaFederalfirearmslicenseeengagedinthebusinessofimporting,manufacturing,ordealinginNFAfirearms.QuestionsregardingSOTshouldbedirectedtotheATFNFABranchat(304)616-4500.

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

U.S. Department of JusticeBureau of Alcohol, Tobacco, Firearms and Explosives Application for Federal Firearms License

OMB No. 1140-0018

Part A

2. Applicant Name (Enter name of Owner/Sole Proprietor OR Partnership (include name of each partner) OR Corporation Name OR LLC Name)

3. Trade or Business Name(s), if any 4. EmployerIdentificationNumber(EIN),ifany(seedefinition#17)

6. Business/Activity Address (RFD or Street Number, City, State,and ZIP Code) (NOTE: This address CANNOT be a P.O. Box.)

7. Mailing Address (ifdifferentfromaddressinitem#6)

8. Contact Numbers (Include Area Code)

9. Describethespecificactivityapplicantisengagedinorintendstoengagein,whichrequiresaFederalFirearmsLicense(saleofammunitionalonedoesnotrequireaFederalFirearmsLicense).

10. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an “X” in the appropriate box(es). Multiple license types may be selected- see instruction#8.Submitthefeenotednexttothebox(es)withtheapplication.Licensesareissuedfora3-yearperiod.Seeinstruction#5forpaymentinformation).

Type DescriptionofLicenseType FeeDealer in Firearms Other than Destructive Devices (Includes: rifles,shotguns,pistols,revolvers,gunsmithactivities,andNationalFirearmsAct(NFA)weapons)(seeinstruction#10) $200

06

01

Manufacturer of Ammunition for Firearms Other Than Ammunition for Destructive Devices or Armor Piercing Ammunition (seeinstruction#11)

Manufacturer of Firearms Other than Destructive Devices(seeinstruction#11)

Importer of Firearms Other than Destructive Devices or Ammunition for Firearms Other than Destructive Devices, or Ammunition Other than Armor Piercing Ammunition(NOTE:Importerofhandgunsandrifles,seeinstruction#9)

Dealer in Destructive Devices (seedefinition#20)

Manufacturer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition(seeinstruction#11)

07

08

09

10

$30

$150

$150

$3000

$3000

5. Name of CountyinwhichBusiness/ActivityisLocated

Business/Activity PhoneCell Phone

Fax NumberBusiness Email

CorporationCollector (whichcanbeanindividual/partnership/corporationorLLC) Other (specify)

Importer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition (see instruction#9)11 $3000

Total Fees

1. Applicant’s Business/Activity is:

11. Method of Payment (Check one)

Name as Printed on Your Credit/Debit CardCredit/Debit Card Number (No dashes)

Credit/Debit Card Billing Address:

Visa Mastercard American Express Discover

Address:

City: State: ZIP Code:

Please complete to ensure payment is credited to the correct application:IampayingtheapplicationfeeforthefollowingPerson,Corporation,orPartnership: Total Application Fees:

Signature of Cardholder

IauthorizeATFtochargemyCredit/DebitCardtheaboveamount.Yourcredit/debitcardwillbechargedtheabovestatedamountuponreceiptofyourapplicationandachargefrom“ATFLicensingFee”willbereflectedonyourcredit/debitcardstatement.IntheeventalicenseisNOTissued,theaboveamountwillbecreditedtothecredit/debitcardnotedabove.

Date

$

Check (Enclosed) Cashier’s Check or Money Order (Enclosed)

PawnbrokerinFirearmsOtherthanDestructiveDevices (Includes: rifles,shotguns,pistols,revolvers,gunsmithactivities,andNationalFirearmsAct(NFA)weapons)(seeinstruction#10) $20002

Collector of Curios and Relics (NOTE:Thisisnotalicensetoconductbusiness,seeinstruction#8) $3003

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

IndividualOwner(Sole Proprietor) Partnership LLC

Expiration Date (MM/YY)

CLEOCopy-Page1

$

20. Applicant Certification (Please read AND INITIAL each box)

12. Hours of Operation and/or Availability of Business/Activity (pleaseprovideatleastonehourinwhichyoucanbecontactedbyATFpersonnel)Sun Mon Tues Wed Thu Fri Sat

Hour(s):Please indicate

AM or PMIF YOU ARE ONLYAPPLYINGFORATYPE03(COLLECTOROFCURIOSANDRELICS)LICENSE,SKIPITEMS13-17ANDGOTOITEM18.

FORALLOTHERLICENSETYPES,CONTINUEWITHITEM13.13. Was the business obtained from someone else? (If “Yes,”

pleaseprovidethenameofthepreviousbusinessandtheirFFL Number)

Name of Previous Business

14. Indicate type of business premisesZoned Commercial:Zoned Residential:

Store FrontOfficeRod&GunClub

SingleFamilyDwellingCondominium/ApartmentHotel/Motel

Military Installation (seeinstruction#13-additionalinformation required)Other (specify)

Public Housing

FederalFirearmsLicenseNumber

OwnedPremises

Rented/LeasedPremises-providename,telephonenumber,andaddressof the property owner:

Military Installation

NoYes

15. Applicant’s business premises is:

Name

Telephone Number (with area code)

Street Address

City, State, and ZIP Code

16. DoyouintendtosellfirearmsatGunShowsand/orconductInternetsales? Yes No

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

17. DoyouintendtouseyourlicenseONLYtoacquirefirearmstoenhanceyourpersonalcollection? Yes No

a. Thebusiness/activitytobeconductedundertheFederalFirearmsLicenseisnotprohibitedbyStateorlocallawatthepremisesshowninitem6.Thisincludescompliancewithzoningordinances. (Please contact your local zoning department PRIOR TO submitting application)

b. Within30daysaftertheapplicationisapproved,thebusiness/activitywillcomplywiththerequirementsofStateandlocallawapplicable to the conduct of the business/activity.

c. Business/activitywillnotbeconductedunderthelicenseuntiltherequirementsofStateandlocallawapplicabletothebusiness/activityhave been met.

d. A completed copy of this application has been sent (mailedordelivered)totheChiefLawEnforcementOfficer(CLEO)ofthelocalityinwhichthepremiseslistedinitem6islocated(seeinstruction#4anddefinition#1).

18. NameofChiefLawEnforcementOfficer(CLEO) (Pleaseprint the name of the CLEO to whom a copy of thisapplicationwasprovided.Seeinstruction#4anddefinition#1.)

19. AddressofCLEO(Include Number, Street, City, County, State, and ZIPCode)

e. Asrequiredby18U.S.C.923(d)(1)(G),IcertifythatsecuregunstorageorsafetydeviceswillbeavailableatanyplaceinwhichfirearmsaresoldunderthisFederalFirearmsLicensetopersonswhoarenotlicensees.(Seedefinition#4)(IfapplyingforaType03,CollectorofCurios and Relics License ONLY,write“N/A”insteadofinitialingthiscertificationbox.)

f. PartBofthisapplicationhasbeencompletedandwillbesubmittedforEACH responsible person (RP) (Seedefinition#3)

21. Certification:Underthepenaltiesimposedby18U.S.C.924,IdeclarethatIhaveexaminedthisapplicationinitsentiretyandthedocumentssubmittedinsupportthereofandtothebestofmyknowledgeandbelief,theyaretrue,correct,andcomplete.Thissignature,whenpresentedbyadulyauthorizedrepresentativeoftheU.S.DepartmentofJustice,willconstituteconsentandauthorityfortheappropriateU.S.Departmentof Justice representative to examine and obtain copies and abstracts of records and to receive statements and information regarding thebackgroundoftheapplicant.Specifically,IherebyauthorizethereleaseofthefollowingdataorrecordstoATF:Militaryinformation/records,medicalinformation/records,policeandcriminalrecords.ThiscertificationmustbesignedbyaResponsiblePerson(seeinstruction#2anddefinition#3).

Print Applicant Name (First, Middle, Last) Applicant Signature Date

ATTENTION Chief Law Enforcement Officer (CLEO): Thisformprovidesnotificationofaperson’sintenttoapplyforaFederalFirearmsLicense(FFL).Itrequiresnoactiononyourpart.However,shouldyouhaveinformationthatmaydisqualifythepersonfromobtainingaFederalFirearmsLicense,pleasecontacttheFederalFirearmsLicensingCentertollfreeat1-866-662-2750.IssuanceofanFFLinnowayguaranteesthebusinessoractivityisnotinviolationofStateand/orlocallaw.

CLEOCopy-Page2

county:

Check Application Status (For ATF Use Only) Abandoned WithdrawnApproved Denied Reason for Denial:

SignatureofLicensingOfficial: Date:

1. LicenseorApplicantName(Fromblock2ofPartA) 2.FederalFirearmsLicenseNumber(IfbeingaddedtoanexistingFFL)

3. Name of Responsible Person (Last, First, Middle) 4. Aliases (Includegiven,married,maidennames)

6. Social Security Number

5. Position/Title

9. Current Residence Address 10. Telephone Number (PersonalContact#withAreaCode)

7. Date of Birth (MM/DD/YYYY) 8. Place of Birth (City & State ORforeigncountry)

13. Sex 14. Height 15. Weight 16. Eye ColorMale

Female

17. Hair Color

Feet

Inches (lbs)BlackBlueBrown

GreenGray

HazelMaroonMultiple

OtherPink

Bald

BlackBlond

GrayBrown

RedSandyWhite

19. Race (Please check one or more boxes)American Indian or Alaska Native

Black or African American

NativeHawaiianorOtherPacificIslanderAsian

HispanicorLatino

White

12. Previous Address(es) - Please provide everyaddressyouhavehadinthelastfiveyearsanddateswhichyoulivedattheaddress(es)(Ifadditional space is needed attach a separatesheet.Seeinstruction#1)

Yes No

20. HaveyoueverheldaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

21. HaveyoueverbeenaResponsiblePersononaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

22. HaveyoueverbeenanofficerinacorporationholdingaFederalFirearmsLicense?(Ifso,pleaseincludeFFL#)

23. HaveyoueverbeenanemployeeofaFederalFirearmsLicensee?

24. HaveyoueverbeendeniedaFederalFirearmsLicense?

25. HaveyoueverhadaFederalFirearmsLicenserevoked?

26. Areyouunderindictmentorinformationinanycourtforafelony,oranyothercrime,forwhichthejudgecouldimprison you for more than one year? (Seedefinition#10)

27. Haveyoueverbeenconvictedinanycourtforafelony,oranyothercrime,forwhichthejudgecouldhaveimprisonedyouformorethan one year, even if you received a shorter sentence including probation? (Seedefinition#10)

28. Areyouafugitivefromjustice?(Seedefinition#11)

29. Are you under 21 years of age?

30. Areyouanunlawfuluserof,oraddictedto,marijuanaoranydepressant,stimulant,narcoticdrug,oranyothercontrolledsubstance?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.

1. EACH RESPONSIBLE PERSON MUST COMPLETE AND SIGN A SEPARATE QUESTIONNAIRE/ATF Form 7/7CR Part B. In the future, ifyouneedtoaddanadditionalResponsiblePersontoyourFFL,theResponsiblePersonbeingaddedmaycompletethisPartB-ResponsiblePerson Questionnaire (see instruction #7).

2. IssuanceofyourlicenseoradditionasaResponsiblePersonwillbedelayedifPartBisincompleteorotherwiseimproperlyprepared.3. IMPORTANT!AllnewresponsiblepersonsmustsubmitaproperlypreparedFD-258(FingerprintCard)withthisquestionnaire.Thefingerprints

mustbeclearforaccurateclassificationandtakenbysomeoneproperlyequippedtotakethem.TheFD-258shouldinclude“WVATF1100ATF-FFLC,MARTINSBURG,WV”intheORIblocktofacilitateprocessingoffingerprints.

4. Listanygiven,married,andmaidennamesinItem4,e.g.,“MaryAlice(Smith)Jones,”not“Mrs.JohnJones.”(If additional space is needed, attachaseparatesheet.Seeinstruction#1)

For the following questions give full details on a separate sheet for all “Yes” answers(seeinstruction#1)

11. E-mail Address

18. EthnicityYes No

Other

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018CLEOCopy-Page3

31. HaveyoueverbeenadjudicatedasamentaldefectiveOR have you ever been committed to a mental institution?(Seedefinitions#12and#13)

32. Have you been discharged from the Armed Forces under dishonorable conditions?33. Areyousubjecttoacourtorderrestrainingyoufromharassing,stalking,orthreateningyourchildoranintimatepartnerorchildof

such partner?(Seedefinition#5)34. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (Seedefinition#7)

Part B - Responsible Person Questionnaire

Yes No

35. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.)

36. Have you ever renounced United States citizenship?

37. AreyouanalienillegallyorunlawfullyintheUnitedStates?

40. Under the penalties imposed by 18 U.S.C. § 924 and 1001, I declare that I have examined any related documents submitted in regard to thisquestionnaire/ATFForm7/7CRPartB,andtothebestofmyknowledgeandbelief,theyaretrue,correctandcomplete.Thissignature,whenpresentedbyadulyauthorizedrepresentativeoftheU.S.DepartmentofJustice,willconstituteconsentandauthorityfortheappropriateU.S.Department of Justice representative to examine and obtain copies and abstracts of records and to receive statements and information regarding mybackground.Specifically,IherebyauthorizethereleaseofthefollowingdataorrecordstoATF:Militaryinformation/records,medicalinformation/records, police and criminal records.

Signature Printed Name Date

Attach a 2” X 2”Photograph Here

If you are applying for a Type 03 ONLY a photograph is not required

1. Photo must have been takenwithinthelastsixmonths.

2. Photo must have been taken in fullfaceviewwithoutahatorheadcovering that obscures the hair orhairline.

3. On back of photograph print fullname, last 4 of SSN, and businessaddress.

Print Full Name

EACH RESPONSIBLE PERSON MUST COMPLETE AND SIGN A SEPARATE QUESTIONNAIRE/ATF FORM 7/7CR PART B

If applying for a NEW FFL:Mailapplication,fingerprintcards,photographs,andapplicationfees,includinga

separate questionnaire/PartBforEACH Responsible Person, to:

FederalFirearmsLicensingCenterP.O. Box 6200-20

Portland, OR 97228-6200

If only adding a RP to an existing FFL: EachReponsiblePersonbeingaddedmustcompleteaseparatequestionnaire/ATFForm7/7CRPartBandmailit,alongwiththeirfingerprintcardandphotograph,to:ATF,Attn:FFLC,244NeedyRd, Martinsburg, WV 25405

Type 03 Applicants:AphotographandfingerprintcardarenotrequiredifyouareapplyingforaType03 Collector of Curios and Relics license only.

Questions:Ifyouhaveanyquestionsrelatingtothisform,pleasecontacttheATFFederalFirearmsLicensingCenterat1-866-662-2750,oryourlocalATFIndustryOperationsOffice.

38. a.AreyouanalienwhohasbeenadmittedtotheUnitedStatesunderanonimmigrantvisa?(Seedefinition#8)

b. If“yes”,doyoufallwithinanyoftheexceptionsstatedindefinition#9?Attachsupportingdocumentationtotheapplication.

39. If you are an alien, record your U.S.-Issued Alien or Admission number(AR#,USCIS#,orI94#):

Paperwork Reduction Act Notice

ThisrequestisinaccordancewiththePaperworkReductionActof1995.Theinformationcollectionisusedtodeterminetheeligibilityoftheapplicanttoengageincertainoperations,todeterminethelocationandextentofoperations,andtodeterminewhethertheoperationswillbeinconformitywithFederallawsandregulations.Theinformationrequestedisrequiredinordertoobtainorretainabenefitandismandatorybystatute(18U.S.C.§923).

Theestimatedaverageburdenassociatedwiththiscollectionofinformationis60minutesperrespondentorrecordkeeper,dependingonindividualcircumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to Reports ManagementOfficer,ResourceManagementStaff,BureauofAlcohol,Tobacco,FirearmsandExplosives,Washington,DC20226.

Anagencymaynotconductorsponsor,andapersonisnotrequiredtorespondto,acollectionofinformationunlessitdisplaysacurrentlyvalidOMBcontrol number.

CLEOCopy-Page4

N/A

ATF E-Form 7(5310.12)/7CR(5310.16) Revised November 2018

United States of America Other Country/Countries (specify):

11.0.0.20130303.1.892433

1. Applicant's Business/Activity is: check box. Individual Owner (Sole Proprietor): 01. Applicant's Business/Activity is: check box. Other (specify): 1. Applicant's Business/Activity is: check box. Partnership: 01. Applicant's Business/Activity is: check box. Corporation: 01. Applicant's Business/Activity is: check box. LLC: 01. Applicant's Business/Activity is: check box. Collector (which can be an individual/partnership/corporation or LLC): 01. Applicant's Business/Activity is: check box. Other (specify): 02. Applicant Name (Enter name of Owner/Sole Proprietor OR Partnership (include name of each partner) OR Corporation Name OR LLC Name): 3. Trade or Business Name(s), if any: 4. Employer Identification Number (EIN), if any (see definition #17): 5. Name of County in which Business/Activity is Located: 6. Business/Activity Address (RFD or Street Number, City, State, and ZIP Code) (NOTE: This address CANNOT be a P.O. Box.): 7. Mailing Address (if different from address in item #6): 8. Contact Numbers (Include Area Code) Business/Activity Phone: 8. Contact Numbers (Include Area Code) Fax Number: 8. Contact Numbers (Include Area Code) Cell Phone: 8. Contact Numbers (Include Area Code) Business Email: 9. Describe the specific activity applicant is engaged in or intends to engage in, which requires a Federal Firearms License (sale of ammunition alone does not require a Federal Firearms License).: 10. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Dealer in Firearms Other than Destructive Devices (Includes: rifles, shotguns, pistols, revolvers, gunsmith activities, and National Firearms Act (NFA) weapons) (see instruction #10) Fee $200: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Pawnbroker in Firearms Other than Destructive Devices (Includes: rifles, shotguns, pistols, revolvers, gunsmith activities, and National Firearms Act (NFA) weapons) (see instruction #10) Fee $200: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Collector of Curios and Relics (NOTE: This is not a license to conduct business, see instruction #8): 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Manufacturer of Ammunition for Firearms Other Than Ammunition for Destructive Devices or Armor Piercing Ammunition (see instruction #11) Fee $30: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Manufacturer of Firearms Other than Destructive Devices (see instruction #11) Fee $150: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Importer of Firearms Other than Destructive Devices or Ammunition for Firearms Other than Destructive Devices, or Ammunition Other than Armor Piercing Ammunition (NOTE: Importer of handguns and rifles, see instruction #9) Fee $150: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Dealer in Destructive Devices (see definition #20) Fee $3000: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Manufacturer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition (see instruction #11) Fee $3000: 010. Application is made for a license under 18 U.S.C. Chapter 44 as a: (Place an "X" in the appropriate box(es). Multiple license types may be selected- see instruction #8. Submit the fee noted next to the box(es) with the application. Licenses are issued for a 3-year period. See instructions #5 for payment information). Importer of Destructive Devices, Ammunition for Destructive Devices, or Armor Piercing Ammunition (see instruction #9) Fee $3000: 0Total Fees $: 0.0000000011. Method of Payment (Check one) Check (Enclosed): 011. Method of Payment (Check one) Cashier's Check or Money Order (Enclosed): 011. Method of Payment (Check one) Visa: 011. Method of Payment (Check one) Mastercard: 011. Method of Payment (Check one) American Express: 011. Method of Payment (Check one) Discover: 011. Method of Payment (Check one) Diner's Club: 0Credit/Debit Card Number (No dashes): Name as Printed on Your Credit/Debit Card: Expiration Date (MM/YY): Credit/Debit Card Billing Address: Address:: Credit/Debit Card Billing Address: City:: Credit/Debit Card Billing Address: State:: Credit/Debit Card Billing Address: ZIP Code:: I am paying the application fee for the following Person, Corporation, or Partnership:: Total Application Fees: $: Signature of Cardholder: Date: Hour(s): Please indicate AM or PM. Sun: Hour(s): Please indicate AM or PM. Mon: Hour(s): Please indicate AM or PM. Tues: Hour(s): Please indicate AM or PM. Wed: Hour(s): Please indicate AM or PM. Thu: Hour(s): Please indicate AM or PM. Fri: Hour(s): Please indicate AM or PM. Sat: 13. Was the business obtained from someone else? (If "Yes," please provide the name of the previous business and their FFL Number) Yes: 013. Was the business obtained from someone else? (If "Yes," please provide the name of the previous business and their FFL Number) No: 013. Was the business obtained from someone else? (If "Yes," please provide the name of the previous business and their FFL Number) Name of Previous Business: 13. Was the business obtained from someone else? (If "Yes," please provide the name of the previous business and their FFL Number) Federal Firearms License Number: 14. Indicate type of business premises. Zoned Residential: Single Family Dwelling: 014. Indicate type of business premises. Zoned Residential: Condominium/Apartment: 014. Indicate type of business premises. Zoned Residential: Hotel/Motel: 014. Indicate type of business premises. Zoned Residential: Public Housing: 014. Indicate type of business premises. Zoned Commercial: Store Front: 014. Indicate type of business premises. Zoned Commercial: Office: 014. Indicate type of business premises. Zoned Commercial: Rod & Gun Club: 014. Indicate type of business premises. Zoned Commercial: Military Installation (see instruction #13-additional information required): 014. Indicate type of business premises. Zoned Commercial: Other (specify): 014. Indicate type of business premises. Zoned Commercial: Other (specify): 15. Applicant's business premises is: Owned Premises: 015. Applicant's business premises is: Military Installation: 015. Applicant's business premises is: Rented/Leased Premises- provide name, telephone number, and address of the property owner:: 015. Applicant's business premises is: Street Address: 15. Applicant's business premises is: Name: 15. Applicant's business premises is: Telephone Number (with area code): 15. Applicant's business premises is: City, State, and ZIP Code: 16. Do you intend to sell firearms at Gun Shows and/or conduct Internet sales? Yes: 016. Do you intend to sell firearms at Gun Shows and/or conduct Internet sales? No: 017. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? Yes: 017. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? No: 018. Name of Chief Law Enforcement Officer (CLEO) (Please print the name of the CLEO to whom a copy of this application was provided. See instruction #4 and definition #1.): 19. Address of CLEO (Include Number, Street, City, Country, State, and ZIP Code): 19. Address of CLEO (Include Number, Street, City, Country, State, and ZIP Code) county:: TextField41: TextField42: TextField43: TextField44: TextField45: TextField46: Print Applicant Name (First, Middle, Last): Applicant Signature: Date: 17. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? No: 017. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? No: 017. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? No: 017. Do you intend to use your license ONLY to acquire firearms to enhance your personal collection? No: 0Reason for Denial:: Signature of Licensing Official:: Date: 1. License or applicant Name (From block 2 of Part A): 2. Federal Firearms License Number (If being added to an existing FFL): 3. Name of Responsible Person (Last, First, Middle): 4. Aliases (Include given, married, maiden names): 5. Position/Title: 6. Social Security Number: 7. Date of Birth (MM/DD/YYYY): 8. Place of Birth (City & State OR foreign country): 9. Current Residence Address: 10. Telephone Number (Personal contact # with Area Code): 11. E-mail Address: 12. Previous Address(es) - Please provide every address you have had in the last five years and dates which you lived at the address(es) (If additional space is needed attach a separate sheet. See instruction #1): 13. Sex. Male: 013. Sex. Female: 018. Ethnicity. Hispanic or Latino. Yes: 018. Ethnicity. Hispanic or Latino. No: 019. Race (Please check one or more boxes) American Indian or Alaska Native: 019. Race (Please check one or more boxes) Black or African American: 019. Race (Please check one or more boxes) Native Hawaiian or Other Pacific Islander: 019. Race (Please check one or more boxes) Asian: 019. Race (Please check one or more boxes) White: 014. Height. Feet: 14. Height. Inches: 15. Weight. lbs: 16. Eye Color. Black: 016. Eye Color. Blue: 016. Eye Color. Brown: 016. Eye Color. Gray: 016. Eye Color. Green: 016. Eye Color. Hazel: 016. Eye Color. Maroon: 016. Eye Color. Multiple: 016. Eye Color. Pink: 016. Eye Color. Other: 017. Hair Color. Bald: 017. Hair Color. Black: 017. Hair Color. Blond: 017. Hair Color. Brown: 017. Hair Color. Gray: 017. Hair Color. Red: 017. Hair Color. Sandy: 017. Hair Color. White: 017. Hair Color. Other: 020. Have you ever held a Federal Firearms License? (If so, please include FFL#) Yes: 021. Have you ever been a Responsible Person on a Federal Firearms License? (If so, please include FFL#) Yes: 022. Have you ever been an officer in a corporation holding a Federal Firearms License? (If so, please include FFL#) Yes: 023. Have you ever been an employee of a Federal Firearms Licensee? Yes: 024. Have you ever been denied a Federal Firearms License? Yes: 025. Have you ever had a Federal Firearms License revoked? Yes: 026. 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 definition #10) Yes: 027. Have you ever been convicted in any court for 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 definition #10) Yes: 028. Are you a fugitive from justice? (See definition #11) Yes: 029. Are you under 21 years of age? Yes: 030. 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. Yes: 031. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? (See definitions #12 and #13) Yes: 032. Have you been discharged from the Armed Forces under dishonorable conditions? Yes: 033. 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 definition #5) Yes: 034. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See definition #7) Yes: 020. Have you ever held a Federal Firearms License? (If so, please include FFL#) No: 021. Have you ever been a Responsible Person on a Federal Firearms License? (If so, please include FFL#) No: 022. Have you ever been an officer in a corporation holding a Federal Firearms License? (If so, please include FFL#) No: 023. Have you ever been an employee of a Federal Firearms Licensee? No: 024. Have you ever been denied a Federal Firearms License? No: 025. Have you ever had a Federal Firearms License revoked? No: 026. 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 definition #10) No: 027. Have you ever been convicted in any court for 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 definition #10) No: 028. Are you a fugitive from justice? (See definition #11) No: 029. Are you under 21 years of age? No: 030. 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. No: 031. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? (See definitions #12 and #13) No: 032. Have you been discharged from the Armed Forces under dishonorable conditions? No: 033. 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 definition #5) No: 034. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See definition #7) No: 016. Eye Color. Other: 17. Hair Color. Other: 20. Have you ever held a Federal Firearms License? (If so, please include FFL#) : 21. Have you ever been a Responsible Person on a Federal Firearms License? (If so, please include FFL#): 22. Have you ever been an officer in a corporation holding a Federal Firearms License? (If so, please include FFL#) : 35. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) United States of America: 035. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) Other country/Countries (specify):: 035. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) Other country/Countries (specify):: 36. Have you ever renounced United States citizenship? Yes: 037. Are you an alien illegally or unlawfully in the United States? Yes: 038. a. Are you an alien who has been admitted to the United States under a nonimmigrant visa? (See definition #8) Yes: 038. b. If "yes", do you fall within any of the exceptions stated in definition #9? Attach supporting documentation to the application. Yes: 036. Have you ever renounced United States citizenship? No: 037. Are you an alien illegally or unlawfully in the United States? No: 038. a. Are you an alien who has been admitted to the United States under a nonimmigrant visa? (See definition #8) No: 038. b. If "yes", do you fall within any of the exceptions stated in definition #9? Attach supporting documentation to the application. No: 038. b. If "yes", do you fall within any of the exceptions stated in definition #9? Attach supporting documentation to the application. N/A: 039. If you are an alien, record your U.S.- Issued Alien or Admission number (AR#, USCIS#, or I94#): Signature: Printed Name: Date: Print Full Name: