Fill - Free fillable Curioapp BOF 4100A, Curio or Relic Firearm Report PDF form

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE

BOF 4100A (Rev. 05/2019) PAGE 1 of 4

CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

Curio or Relic Firearm Report

California Penal Code section 27565.

A processing fee of $19.00 must accompany application.

(Instructions on Reverse)

A. Owner Information

Last Name: First Name: Middle Name:

Alias Last Name (if any):

Alias First Name: Alias Middle Name:

Residence Street Address: City: State: Zip Code:

Mailing Address (if different):

City:

State: Zip Code:

Date of Birth (mm/dd/yyyy):

Place of Birth (state or country): Sex: Height: Weight: Phone No. (include area code):

U.S.

Citizen?

Yes

If no, enter Alien Registration No. or I-94 No.: Country of Citizenship:

FFL Number:

Expiration Date (mm/dd/yyyy):

Enter your California

driver license (CDL) or

California ID (CID) in the

ID number box to the right.

ID Type (check one)

CDL CID

ID Number:

C. Declaration

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I expressly authorize the Department of

Justice to perform firearms eligibility checks of all relevant state and federal databases, including the Federal Bureau of Investigation's National Instant

Criminal Background Check System. I also understand that if I currently possess or 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

B. Firearm(s) Information (To report additional firearm(s) copy and attach additional applications)

Firearm

Type:

Long Gun

Handgun

Long Gun:

Rifle

Shotgun

Handgun:

Semiauto

Revolver

Single-Shot

Other:

Serial Number:

Make:

Model: Caliber: Firearm Origin:

Barrel Length:

IN.

CM.

Color: Date Acquired (mm/dd/yyyy):

Acquired From:

Firearms Dealer

Private Party

Family Member (Specify Relationship):

Gun Show Other:

Firearm

Type:

Long Gun

Handgun

Long Gun:

Rifle

Shotgun

Handgun:

Semiauto

Revolver

Single-Shot

Other:

Serial Number:

Make:

Model: Caliber: Firearm Origin: Barrel Length:

IN.

Color: Date Acquired (mm/dd/yyyy):

Acquired From:

Firearms Dealer

Private Party

Family Member (Specify Relationship):

Gun Show Other:

Firearm

Type:

Long Gun

Handgun

Long Gun:

Rifle

Shotgun

Handgun:

Semiauto

Revolver

Single-Shot

Other:

Serial Number:

Make:

Model:

Caliber:

Firearm Origin:

Barrel Length:

IN.

CM.

Color: Date Acquired (mm/dd/yyyy):

Acquired From:

Firearms Dealer

Private Party

Family Member (Specify Relationship):

Gun Show Other:

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE

BOF 4100A (Rev. 05/2019) PAGE 2 of 4

CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

Curio or Relic Firearm Report

Curio or Relic Firearm Report Submission Requirements

State law requires all California Federal Firearms Licensees (FFL) holding a type "03" license (collectors of curio or relic

firearms) who obtain curio or relic firearms while out of state, to report such purchases or acquisitions to the California

Department of Justice within five days of transporting the firearm(s) into California. Your failure to comply with this

mandated reporting requirement could result in criminal prosecution. (Pen. Code, §§ 27590 & 27565)

The following must be submitted with your application and mailed to the Department of Justice, Bureau of Firearms-C&R,

P.O. Box 820200, Sacramento CA 94203-0200:

■ $19.00 processing fee (check or money order made payable to the Department of Justice)

(Pen. Code, § 28230, (a)(3))

■ A copy of your California driver license or identification card. (Cal. Code Reg., tit 11, § 4045.1)

■ If your California driver license or identification card has “FEDERAL LIMITS APPLY” on the front, you shall also

submit proof of lawful presence in the United States, in the form of one of the following documents:

(1) Valid, unexpired U.S. passport or passport card.

(2) Certified copy of U.S. birth certificate.

(3) Certification of Birth Abroad (FS-545), Certification of Report of Birth (DS-1350) or Consular Report of Birth

Abroad of a Citizen of the United States of America (FS-240), issued by the U.S. Department of State.

(4) Valid, unexpired foreign passport with valid U.S. immigrant visa and approved Record of Arrival/Departure (I-94)

form.

(5) Certified copy of birth certificate from a U.S. Territory.

(6) Certificate of Naturalization or U.S. Citizenship.

(7) Valid, unexpired Permanent Resident Card. (Cal. Code Reg., tit 11, § 4045.1)

■ If your name, as it appears on the “FEDERAL LIMITS APPLY” California driver license or identification card, differs

from the name on the document(s) above, you shall also submit one of the following certified documents:

(1) An adoption document that contains your legal name as a result of the adoption.

(2) A name change document that contains your legal name both before and, as a result of, the name change.

(3) A marriage certificate.

(4) A dissolution of marriage document that contains your legal name as a result of the court action.

(5) A certificate, declaration or registration document verifying the formation of a domestic partnership.

(6) A dissolution of domestic partnership document that contains your legal name as a result of the court action. (Cal.

Code Reg., tit 11, § 4045.1)

Complete all required information. Incomplete applications submitted without the proper fees and documentation will be

returned without processing. If reporting more than three firearms, attach additional copies of this form as needed. 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 Curio or Relic Firearm Report.

This form may not be used to report ownership of assault weapons defined in Penal Code sections 30510 through 30530. 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 Bureau of Firearms website at www.oag.ca.gov/firearms.

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE

BOF 4100A (Rev. 05/2019) PAGE 3 of 4

CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

Curio or Relic Firearm Report

Part A. Owner Information

Enter the information as requested. Only one applicant per form.

Part B. Firearm Information

For each firearm, you must provide the identification information requested. Please refer to your firearm owner's manual, the

firearms manufacturer's website, or the examples below to assist you in providing the required information:

• Serial Number Usually located on the frame of a handgun, or the receiver of a long gun. May be all numeric

or a combination of alpha and numeric characters. (e.g., 98765, US54321G)

• Make The manufacturer of the firearm. (e.g., Remington, Winchester, Glock, Smith & Wesson)

• Model The model name of the firearm. (e.g., 870 Express, Model 70, 17C, 29-10)

• Caliber The caliber of the firearm. (e.g., 12 gauge, .308 Winchester, 9 mm, .44 Magnum)

• Firearm Origin The country of origin of the firearm. (e.g., United States, Russia, China, Italy)

• Barrel Length Enter the barrel length as stated either in your owner's manual, manufacturer's website, or

measure the barrel length by closing the action of the firearm 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.

Part C. Declaration

You must sign and date the declaration on this application.

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE

BOF 4100A (Rev. 05/2019) PAGE 4 of 4

CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

Curio or Relic Firearm Report

Collection and Use of Personal Information. The Division of Law Enforcement in the Department of

Justice collects the information requested on this form as authorized by Penal Code section 27565,

subdivision (a). The Division of Law Enforcement uses this information to record a collector's firearm

acquisition. In addition, any personal information collected by state agencies is subject to the limitations

in the Information Practices Act and state policy. The Department of Justice's general privacy policy is

available at http://oag.ca.gov/privacy-policy.

Providing Personal Information. All the personal information requested in the form must be provided.

If you fail to provide any of the required personal information, the unprocessed report will be returned to

you for completion and resubmission.

Access to Your Information. You may review the records maintained by the Division of Law

Enforcement in the Department of Justice that contain your personal information, as permitted by the

Information Practices Act. See below for contact information.

Possible Disclosure of Personal Information. In order to ensure you are not prohibited from and

record a collector's firearm acquisition, we may need to share the information you give us with entities as

authorized in Penal Code section 11105. The information you provide may also be disclosed in the

following circumstances:

■ With other persons or agencies when necessary to perform their legal duties, and their use of

your information is compatible and complies with state law, such as for investigations or for

licensing, certification, or regulatory purposes;

■ To another government agency as required by state or federal law.

Contact Information. For questions about this notice or access to your records, you may contact the

Staff Services Analyst in the Customer Support Center at (916) 227-7527, via email at

firearms.bureau@doj.ca.gov or by mail at P.O. Box 820200, Sacramento, CA 94203-0200.

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