STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
BOF 116 (Rev. 05/2019) PAGE 1 of 4
CALIFORNIA DEPARTMENT OF JUSTICE
BUREAU OF FIREARMS
Personal Firearm Eligibility Check Application
Penal Code Section 30105
This application must be notarized by a licensed California Notary Public.
See reverse for instructions and fees.
Last Name Suffix First Name Middle Name
Alias Last Name (if any)
Alias First Name Alias Middle Name
Date of Birth (mm/dd/yyyy)
California Driver License or ID No.
(copy must accompany application)
If no, enter Alien Registration No. or I-94 No.
Weight Eye Color Hair Color Race Telephone Number
Residence Street Address City State Zip Code
Mailing Address (if different) City State Zip Code
No person or agency may require or request another person to obtain a firearms eligibility check or notification of firearms eligibility check
pursuant to Penal Code section 30105, subdivision (h). A violation of this subdivision is a misdemeanor.
If the applicant for a firearms eligibility check purchases, transfers, or receives a firearm through a licensed dealer as required by law, a
waiting period and background check are both required.
CERTIFICATE OF ACKNOWLEDGEMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who
signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of
State of California
County of ________________________________
On __________________________ before me, __________________________________________,personally
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity
(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true
WITNESS my hand and official seal.
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 as permitted under the law. I also
understand that if I currently possess/own firearms and the results of this check reveal that I am ineligible to lawfully either possess or
purchase firearms, I must relinquish any and all firearms, ammunition, and firearm magazines in my possession.
Signature (must be notarized above) Date
FOR DOJ USE ONLY
Determination could not be made: