Fillable Form 5320.23 (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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Form 5320.23 (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
National Firearms Act (NFA)
Responsible Person Questionnaire
OMB No. 1140-0107 (08/31/2022)
3e. Photograph
Ax recent
Photograph Here
(Approximately 2” x 2” )
(See instruction 3b)
7. Law Enforcement Notication (See instruction 5)
As a responsible person (see denition 4) of the trust or legal entity identied in Item 2 of this form, I am required to provide notication of the proposed making or
acquisition and possession of the rearm described in item 4 of this form by providing a copy of the completed form to the chief law enforcement ocer (CLEO) in the
agency identied below:
1. Please check the appropriate box to indicate with which ATF form this questionnaire will be submitted.
ATF Form 1
ATF Form 5ATF Form 4
2. Full Legal Name and Address of Applicant or Transferee (as shown on the ATF Form 1, 4 or 5) (see instruction 2)
Complete the form in duplicate. The ATF copy of the form, with ngerprints on Form FD-258 and photograph, will be submitted with the ATF Form 1, 4, or 5 (to the address
shown on the specic form) and the other copy will be directed to the responsible person’s chief law enforcement ocer. (See Instructions)
3a. Full Legal Name and Home Address of Responsible Person
3c. E-mail address
3d. Other names used (including alias and maiden name)
3b. Telephone (Area code and Number)
4a. Type of Firearm (see denition 5)
4b. Name and Address of Maker, Manufacturer and/or Importer of Firearm
4c. Firearm Model 4e. Firearm Serial Number
Agency or Department Name
Address (Street address or P.O. Box, City, State and Zip Code) to which sent (mailed or delivered)
This form provides notication of the maker or transferee’s intent to make or acquire and possess a National Firearms Act (NFA) rearm. No action on your part is required.
However, should you have information that may disqualify this person from making or possessing a rearm, please contact the NFA Branch at (304) 616-4500 or NFA@atf.
gov. A “Yes” answer to items 8.a. through 8.h. or item 9.d. or 9.e. could disqualify a person from acquiring or possessing a rearm. Also, ATF may not approve an
application if the transfer or possession of the rearm would be in violation of State or local law.
ATF Form 5320. 23
Revised September 2019
Information for the Chief Law Enforcement Ocer
Name and Title of Ocial
4d. Caliber or Gauge
ATF Copy
5. Social Security Number: (See instructions 3C)
Date of Birth:
American Indian or Alaska Native
Black or African American White
Asian
Native Hawaiian or Other Pacic Islander
6b. Race
6a. Ethnicity
Hispanic or Latino
Not Hispanic or Latino
8. Answer questions 8.a. through 8.h. Answer questions 9 and 10, if applicable. For any “Yes” answer the transferee shall provide details on a separate sheet.
(See denitions 8-14)
Yes No
a. 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 denition 8)
b. 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 denition 8)
c. Are you a fugitive from justice? (See denition 13)
d. 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.
e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? (See denitions 9 and 10)
f. Have you been discharged from the Armed Forces under dishonorable conditions?
h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See denition 14)
g. 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 denition 11)
CERTIFICATION: Under penalties imposed by 18 U.S.C.
§
924 and 26 U.S.C.
§
5861, I certify that, upon submission of this form to ATF, a completed copy of
this form will be directed to the chief law enforcement ocer (CLEO) shown in item 5, that the statements contained in this certication, and any attached
documents in support thereof, are true and correct to the best of my knowledge and belief.
Signature of Responsible Person Date
Instructions
1. Completion: Each responsible person (see denition 4) of a trust or legal entity seeking to make or acquire a National Firearms Act (NFA) rearm shall complete this
form in duplicate. (see instruction 9)
a. Each responsible person must submit his/her ngerprints and photograph with this form (see below).
b. Please note that this form is not required when the applicant on Form 1, 4 or 5 is an individual.
2. Item 2- Enter the name, trade name (if any) and address of the trust or legal entity identied on the Form 1 (items 3a and b); Form 4 (item 2a); or Form 5 (item 2a)
3. Item 3- Responsible Person information
a. Provide the information for the responsible person in items 3a through 3e.
b. Item 3e - Photograph: The responsible person shall attach, in item 3e on the ATF copy of the form only, a 2-inch by 2-inch frontal view photograph taken within
one year prior to the date of the ling of the form. Item 3c is obscured on the CLEO copy.
c. Social Security Number and UPIN. The Social Security number and UPIN are not required. However, this information assists with the ecient completion of the
NICS background check. Please be aware that refusal to provide this information may result in a delay in the NICS background check process.
4. Firearm information
a. Type of NFA rearm: see denition 5 and as identied in item 4b of Form 1, 4, or 5
b. Name of maker, manufacturer and/or importer: as identied in item 4a of Form 1, 4 or 5
c. Firearm Model: identied in item 4d of Form 1, 4 or 5
d. Caliber or Gauge: identied in item 4c of Form 1, 4 or 5
e. Firearm Serial Number: identied in item 4g of Form 1, 4 or 5. Item 4e is obscured on the CLEO copy.
5. Item 6- Law Enforcement Notication: Each responsible person must provide a notication on this form of the proposed making or acquisition of an NFA rearm to
his/her chief law enforcement ocer having jurisdiction where the responsible person is located. The chief law enforcement ocer is considered to be the
Chief of Police; the Sheri; the Head of the State Police; or a State or local district attorney or prosecutor.
6. Complete items 7 through 10
7. Fingerprints: The responsible person shall submit, in duplicate with the ATF copy of this form, his or her ngerprints on FBI Form FD-258 and the ngerprints must be
clear for accurate classication and taken by someone properly equipped to take them. No ngerprints are required with the copy of the form sent to the chief law
enforcement ocer.
8. State or Local Permit: If the State in which the responsible person resides requires the responsible person to have a State or Local permit or licensee, a copy of the
permit or license must be submitted with this form.
9. Disposition: The ATF copy of the form, with the ngerprints and photograph, shall be submitted with the ATF Form 1, 4 or 5. The other copy shall be directed to the
responsible person’s chief law enforcement ocer identied in item 5 of this form.
10. Sign and date the form. The signature must be original. Exceptions: In the case of eforms or where a variance has been granted a Digital/Electronic signature may be
used.
ATF Form 5320. 23
Revised September 2019
Yes No
e. Are you an alien illegally or unlawfully in the United States?
N/A
10. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or I94#):
f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
f.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the questionnaire
d. Have you ever renounced your United States citizenship?
9a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See denition 12)
United States of America
Other Country/Countries (specify):
ATF Copy
9b. State of Birth 9c. Country of Birth
11. Have you been issued a Unique Personal Identication Number (UPIN)? (See instructions 3C) If yes please list
Yes No
click to sign
signature
click to edit
DEFINITIONS
1. National Firearms Act (NFA). Title 26, United States Code, Chapter 53. The implementing regulations are found in Title 27, Code of Federal Regulations, Part 479.
2. Gun Control Act (GCA). Title 18, United States Code, Chapter 44. The implementing regulations are found in Title 27, Code of Federal Regulations, Part 478.
3. Person. A partnership, company, association, trust, corporation, including each responsible person associated with such an entity; an estate; or an individual.
Section A
4. Responsible Person. In the case of an unlicensed entity, including any trust, partnership, association, company (including any Limited Liability Company (LLC)), or
corporation, any individual who possesses, directly or indirectly, the power or authority to direct the management and policies of the trust or entity to receive, possess,
ship, transport, deliver, transfer or otherwise dispose of a rearm for, or on behalf of, the trust or legal entity.
Section B
Trust: Those persons with the power or authority to direct the management and policies of the trust includes any person who has the capability to exercise such power
and possesses, directly or indirectly, the power or authority under any trust instrument, or under State law, to receive, possess, ship, transport, deliver, transfer, or other
wise dispose of a rearm for, or on behalf of the trust. Examples of who may be considered a responsible person include settlors/grantors, trustees, partners, members,
ocers, directors, board members, or owners. An example of who may be excluded from this denition of responsible person is the beneciary of a trust, if the
beneciary does not have the capability to exercise the enumerated powers or authorities.
5. Firearm. (1) a shotgun having a barrel or barrels of less than 18 inches in length; (2) a weapon made from a shotgun if such weapon as modied has an overall length
of less than 26 inches or a barrel or barrels of less than 18 inches in length; (3) a rie having a barrel or barrels of less than 16 inches in length; (4) a weapon made from
a rie if such weapon as modied has an overall length of less than 26 inches or a barrel or barrels of less than 16 inches in length; (5) any other weapon as dened in
26 U.S.C. § 5845(e); (6) a machinegun; (7) any silencer (as dened in 18 U.S.C. § 921) and (8) a destructive device.
6. Maker. The person (applicant) applying to make and register the rearm.
7. Transferee. The person acquiring the rearm.
8. Prohibited Person. Generally, 18 U.S.C. § 922(g) prohibits the shipment, transportation, receipt, or possession in or aecting interstate commerce of a rearm by one
who has been convicted of a felony or any other crime, punishable by imprisonment for a term exceeding one year (this does not include State misdemeanors
punishable by imprisonment of two years or less), is a fugitive from justice, is an unlawful user of or addicted to marijuana or any depressant, stimulant, or narcotic
drug, or any other controlled substance, has been adjudicated as a mental defective or has been committed to a mental institution, has been discharged from the Armed
Forces under dishonorable conditions, has renounced his or her U.S. citizenship, is an alien illegally in the United States or an alien admitted to the United States under
a nonimmigrant visa or is subject to certain restraining orders. Furthermore, Section 922(n) prohibits the shipment, transportation, or receipt in or aecting interstate
commerce of a rearm by one who is under indictment or information for a felony in any Federal, State or local court, or any other crime, punishable by imprisonment
for a term exceeding one year. An information is a formal accusation of a crime veried by a prosecutor.
EXCEPTION: A person who has been convicted of a felony or any other crime, for which the judge could have imprisoned the person for more than one year,
or who has been convicted of a misdemeanor crime of domestic violence, is not prohibited from purchasing, receiving, or possessing a rearm if: (1) under the law of
the jurisdiction where the conviction occurred the person has been pardoned, the conviction has been expunged or set aside, or the person had their civil rights (the
right to vote, sit on a jury and hold public oce) taken away and later restored AND (2) the person is not prohibited by the law of the jursidiction where the conviction
occurred from receiving or possessing rearms. Person subject to this exception should mark “no” in the applicable box.
9. Adjudicated as a Mental Defective. A determination by a court, board, commission, or other lawful authority that a person, as a result of marked subnormal
intelligence, or mental illness, incompetency, condition, or disease; (1) is a danger to himself or to others; or (2) lacks the mental capacity to contract or manage his
own aairs. This term shall include (1) a nding of insanity by a court in a criminal case, and (2) those persons found incompetent to stand trial or found not guilty by
reason of lack of mental responsibility.
10. Committed to a Mental Institution. A formal commitment of a person to a mental institution by a court, board, commission, or other lawful authority. The term
includes a commitment to a mental institution involuntarily. The term includes commitment for mental defectiveness or mental illness. It includes commitments for
other reasons, such as for drug use. The term does not include a person in a mental institution for observation or a voluntary admission to a mental institution.
EXCEPTION: NICS Improvement Amendments Act of 2007: A person who has been adjudicated as a mental defective or committed to a mental institution
in a state proceeding is not prohibited by the adjudication or commitment if the person has been granted relief by the adjudicating /committing state pursuant to a
qualifying mental health relief from disabilities program. Also, a person who has been adjudicated as a mental defective or committed to a mental
institution by a department or agency of the Federal Government is not prohibited by the adjudication or commitment if either; (a) the person’s adjudication or commit
ment was set-aside or expunged by the adjudicating/committing agency; (b) the person has been fully released or discharged from all mandatory treatment, supervision,
or monitoring by the agency; (c) the person was found by the agency to no longer suer from the mental health condition that served as the basis of the initial adjudica
tion/commitment; or (d) the adjudication or commitment, respectively, is based solely on a medical nding of disability, without an opportunity for a hearing by a court,
board, commission, or other lawful authority, and the person has not been adjudicated as a mental defective consistent with section 922(g)(4) of title 18, United States
Code; or (e) the person was granted relief from the adjudicating/committing agency pursuant to a qualied mental health relief from disabilities program.
Persons who fall within one of the above exceptions should mark “no” in the applicable box. This exception to an adjudication or commitment by a Federal department
or agency does not apply to any person who was adjudicated to be not guilty by reason of insanity, or based on a lack of mental responsibility, or found incompetent to
stand trial, in any criminal case or under the Uniform Code of Military Justice.
11. Restraining Order. Under 18 U.S.C § 922 rearms may not be sold to or received by person subject to a court order that (A) was issued after a hearing which the
person received actual notice of and had an opportunity, to participate in (B) restrains such person from harassing, stalking, or threatening an intimate partner or
child of such intimate partner or person, or engaging in other conduct that would place an intimate partner in reasonable fear of bodily injury to the partner or child,
and (C)(i) includes a nding that such person represents a credible threat the physical safety of such intimate partner or child, or (ii) by its terms explicitly prohibits
the use, attempted use, or threatended use of physical force against such intimate partner or child that would reasonably be expected to cause bodily injury. An
“intimate partner” of a person is the spouse or former spouse of the person, the parent of a child of the person or an individual who cohabitates or has cohabitated
with the person.
ATF Form 5320. 23
Revised September 2019
Privacy Act Information
The following information is provided pursuant to Section 3 of the Privacy Act of 1974 (5 U.S.C. § 552(e)(3)):
1. Authority: Solicitation of this information is made pursuant to the National Firearms Act (NFA) 26 U.S. C. §§ 5812 and 5822. Disclosure of this information by the
applicant is mandatory for the making or transfer of an NFA rearm.
2. Purpose: To ensure payment of the tax imposed by 26 U.S.C. §§ 5811 and 5821; to ensure that the making or transfer would not violate law; and to eect the
registration of the rearm.
3. Routine Uses: The information will be used by ATF to make the determinations set forth in paragraph 2. In addition, to eect registration of the rearm, the
description of the rearm, date of registration, and identication and address of the person entitled to possess the rearm will be entered into the National Firearms
Registration and Transfer Record.
4. Eect of not Supplying Information Requested: Failure to supply complete informatiion may delay processing and may cause denial of the application.
This information request is in accordance with the Paperwork Reduction Act of 1995. The information provided is used in applying to make or transfer NFA rearms. Data
is used to identify the maker; the transferor and transferee; and the rearm being made or transferred; and to ensure legality of the making or transfer.
The estimated burden associated with this collection of information is .25 hours per respondent or recordkeeper, depending upon individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Ocer, Information Technology
Coordination Sta, Bureau of Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Paperwork Reduction Act Notice
ATF Form 5320. 23
Revised September 2019
12. Alien Admitted to the United States Under a Nonimmigrant Visa. An alien admitted to the United States under a nonimmigrant visa includes, among others,
persons visiting the United States temporarily for business or pleasure, persons studying in the United States who maintain a residence abroad, and certain temporary
foreign workers. These aliens must answer “yes” to question 7.d.1 and provide the additional documentation required under question 7.d.2. Permanent resident aliens
and aliens legally admitted to the United States pursuant to either the Visa Waiver Program or to regulations otherwise exempting them from visa requirements may
answer “no” to this question and are not required to submit the additional documentation uder 7.d.2. An alien admitted to the United States under a nonimmigrant
visa is not prohibited from purchasing, receiving or possessing a rearm if the alien (1) is in possession of a hunting license or permit lawfully issued by the Federal
Government, a State, or local government, or an Indian tribe federally recognized by the Bureau of Indian Aairs, which is valid and unexpired;
(2) was admitted to the United States for lawful hunting or sporting purposes; (3) is an ocial representative of a foreign government who is accredited to the United
States Government or the Government’s mission to an international organization having its headquarters in the United States; (4) is an ocial representative of a
foreign government who is en route to or from another country to which that alien is accredited; (5) is an ocial of a foreign government or a distinguished foreign
visitor who has been so designated by the Department of State; (6) is a foreign law enforcement ocer of a friendly foreign government entering the United States on
ocial law enforcement business; (7) has received a waiver from the prohibition from the Attorney General of the United States.
13. Fugitives from Justice. Any person who has ed from any State to avoid prosecution for a felony or a misdemeanor, or any person who leaves the State to avoid
giving testimony in any criminal proceeding. The term also includes any person who knows that misdemeanor or felony charges are pending against such person and
who leaves the State of prosecution.
14. Misdemeanor Crime of Domestic Violence: A Federal, State, local, tribal oense that is a misdemeanor under the Federal, State, or tribal law and has, as an element,
the use or attempted use of physical force, or the threatened use of a deadly weapon, committed by a current or former spouse, parent, or guardian of the victim,
by a person with whom the victim shares a child in common, by a person cohabitating with, or has cohabited with the 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 all misdemeanors that have as an element the use or attempted use of
physical force or the threatened use of a deadly weapon (e.g., assault and battery), if the oense is committed by one of the dened parties. (See Exception in the
denition of “Prohibited Person”). A person who has been convicted of a misdemeanor crime of domestic violence also is not prohibited unless (1) the person was
represented by a lawyer or gave up the right to a lawyer; or (2) if the person was entitled to a jury, was tried by a jury, or gave up the right to a jury trial.
Persons subject to this exception should mark “no” in the applicable box.
CLEO Copy
U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
National Firearms Act (NFA)
Responsible Person Questionnaire
OMB No. 1140-0107 (08/31/2022)
7. Law Enforcement Notication (See instruction 5)
As a responsible person (see denition 4) of the trust or legal entity identied in Item 2 of this form, I am required to provide notication of the proposed making or
acquisition and possession of the rearm described in item 4 of this form by providing a copy of the completed form to the chief law enforcement ocer (CLEO) in the
agency identied below:
1. Please check the appropriate box to indicate with which ATF form this questionnaire will be submitted.
ATF Form 1
ATF Form 5ATF Form 4
2. Full Legal Name and Address of Applicant or Transferee (as shown on the ATF Form 1, 4 or 5) (see instruction 2)
Complete the form in duplicate. The ATF copy of the form, with ngerprints on Form FD-258 and photograph, will be submitted with the ATF Form 1, 4, or 5 (to the address
shown on the specic form) and the other copy will be directed to the responsible person’s chief law enforcement ocer. (See Instructions)
3a. Full Legal Name and Home Address of Responsible Person
3c. E-mail address
3d. Other names used (including alias and maiden name)
3b. Telephone (Area code and Number)
4a. Type of Firearm (see denition 5)
4b. Name and Address of Maker, Manufacturer and/or Importer of Firearm
4c. Firearm Model
Agency or Department Name
Address (Street address or P.O. Box, City, State and Zip Code) to which sent (mailed or delivered)
This form provides notication of the maker or transferee’s intent to make or acquire and possess a National Firearms Act (NFA) rearm. No action on your part is required.
However, should you have information that may disqualify this person from making or possessing a rearm, please contact the NFA Branch at (304) 616-4500 or NFA@atf.
gov. A “Yes” answer to items 8.a. through 8.h. or item 9.d. or 9.e. could disqualify a person from acquiring or possessing a rearm. Also, ATF may not approve an
application if the transfer or possession of the rearm would be in violation of State or local law.
ATF Form 5320. 23
Revised September 2019
Information for the Chief Law Enforcement Ocer
Name and Title of Ocial
4d. Caliber or Gauge
Date of Birth:
American Indian or Alaska Native
Black or African American White
Asian
Native Hawaiian or Other Pacic Islander
6b. Race
6a. Ethnicity
Hispanic or Latino
Not Hispanic or Latino
CLEO Copy
8. Answer questions 8.a. through 8.h. Answer questions 9 and 10, if applicable. For any “Yes” answer the transferee shall provide details on a separate sheet.
(See denitions 8-14)
Yes No
a. 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 denition 8)
b. 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 denition 8)
c. Are you a fugitive from justice? (See denition 13)
d. 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.
e. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? (See denitions 9 and 10)
f. Have you been discharged from the Armed Forces under dishonorable conditions?
h. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? (See denition 14)
g. 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 denition 11)
CERTIFICATION: Under penalties imposed by 18 U.S.C.
§
924 and 26 U.S.C.
§
5861, I certify that, upon submission of this form to ATF, a completed copy of
this form will be directed to the chief law enforcement ocer (CLEO) shown in item 5, that the statements contained in this certication, and any attached
documents in support thereof, are true and correct to the best of my knowledge and belief.
Signature of Responsible Person Date
Instructions
1. Completion: Each responsible person (see denition 4) of a trust or legal entity seeking to make or acquire a National Firearms Act (NFA) rearm shall complete this
form in duplicate. (see instruction 9)
a. Each responsible person must submit his/her ngerprints and photograph with this form (see below).
b. Please note that this form is not required when the applicant on Form 1, 4 or 5 is an individual.
2. Item 2- Enter the name, trade name (if any) and address of the trust or legal entity identied on the Form 1 (items 3a and b); Form 4 (item 2a); or Form 5 (item 2a)
3. Item 3- Responsible Person information
a. Provide the information for the responsible person in items 3a through 3e.
b. Item 3e - Photograph: The responsible person shall attach, in item 3e on the ATF copy of the form only, a 2-inch by 2-inch frontal view photograph taken within
one year prior to the date of the ling of the form. Item 3c is obscured on the CLEO copy.
c. Social Security Number and UPIN. The Social Security number and UPIN are not required. However, this information assists with the ecient completion of the
NICS background check. Please be aware that refusal to provide this information may result in a delay in the NICS background check process.
4. Firearm information
a. Type of NFA rearm: see denition 5 and as identied in item 4b of Form 1, 4, or 5
b. Name of maker, manufacturer and/or importer: as identied in item 4a of Form 1, 4 or 5
c. Firearm Model: identied in item 4d of Form 1, 4 or 5
d. Caliber or Gauge: identied in item 4c of Form 1, 4 or 5
e. Firearm Serial Number: identied in item 4g of Form 1, 4 or 5. Item 4e is obscured on the CLEO copy.
5. Item 6- Law Enforcement Notication: Each responsible person must provide a notication on this form of the proposed making or acquisition of an NFA rearm to
his/her chief law enforcement ocer having jurisdiction where the responsible person is located. The chief law enforcement ocer is considered to be the
Chief of Police; the Sheri; the Head of the State Police; or a State or local district attorney or prosecutor.
6. Complete items 7 through 10
7. Fingerprints: The responsible person shall submit, in duplicate with the ATF copy of this form, his or her ngerprints on FBI Form FD-258 and the ngerprints must be
clear for accurate classication and taken by someone properly equipped to take them. No ngerprints are required with the copy of the form sent to the chief law
enforcement ocer.
8. State or Local Permit: If the State in which the responsible person resides requires the responsible person to have a State or Local permit or licensee, a copy of the
permit or license must be submitted with this form.
9. Disposition: The ATF copy of the form, with the ngerprints and photograph, shall be submitted with the ATF Form 1, 4 or 5. The other copy shall be directed to the
responsible person’s chief law enforcement ocer identied in item 5 of this form.
10. Sign and date the form. The signature must be original. Exceptions: In the case of eforms or where a variance has been granted a Digital/Electronic signature may be
used.
ATF Form 5320. 23
Revised September 2019
Yes No
e. Are you an alien illegally or unlawfully in the United States?
N/A
10. If you are an alien, record your U.S.-Issued Alien or Admission number (AR#, USCIS#, or I94#):
f.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
f.2. If “yes”, do you fall within any of the exceptions stated in the instructions? Attach the documentation to the questionnaire
d. Have you ever renounced your United States citizenship?
9a. Country of Citizenship: (Check/List more than one, if applicable. Nationals of the United States may check U.S.A.) (See denition 12)
United States of America
Other Country/Countries (specify):
9b. State of Birth 9c. Country of Birth
11. Have you been issued a Unique Personal Identication Number (UPIN)? (See instructions 3C) If yes please list
Yes No
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Form 5320.23 (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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Completed 20 July 2020

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