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
No
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
If
Long Gun:
Rifle
Shotgun
If
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
If
Long Gun:
Rifle
Shotgun
If
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
If
Long Gun:
Rifle
Shotgun
If
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.
Privacy Notice
As Required by Civil Code § 1798.17
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