Fillable Sale or Transfer of All Firearms (State of Connecticut/Department of Administrative Services)

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Sale or Transfer of All Firearms (State of Connecticut/Department of Administrative Services)

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STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Sale or Transfer of All Firearms
Date of Sale
Sale Authorization No.
Manufacturer
Exact Model
Serial Number
Caliber/Gauge
General Description
Barrel Length
Handgun
Place of Birth
Long Gun
Other *
Unfinished
Frame/Receiver
Purchaser or Transferee (Print First, Middle, Last Name)
Purchaser or Transferee’s Pistol Permit, Eligibility
Certificate, Police ID or FFL #
Purchaser or Transferee’s Address (No., Street, City/Town, ZIP Code)
Seller or Transferor’s (Print First, Middle, Last Name)
Seller or Transferor’s Pistol Permit, Eligibility Certificate,
Police ID or FFL #
Date of Birth
Seller or Transferor’s Address (No., Street, City/Town, ZIP Code)
Signature of Seller or Transferor
Signature of Purchaser or Transferee
Seller, obtain authorization number by calling (860) 685-8400. Retain the original copy for your records, give one copy to the purchaser as a
receipt, submit one copy to the local police authority where the purchaser resides, and submit a final copy to the Department of Emergency
Services and Public Protection, Special Licensing and Firearms Unit, 1111 Country Club Road, Middletown, Connecticut 06457-2389.
DPS-3-C (Rev. 10/01/19) * “Other” refers to frames, receivers, NFA weapons, etc. See instructions for Question 18 on ATF form 4473
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
Sale or Transfer of All Firearms
Date of Sale
Sale Authorization No.
Manufacturer
Exact Model
Serial Number
Caliber/Gauge
General Description
Barrel Length
Handgun
Place of Birth
Long Gun
Other *
Unfinished
Frame/Receiver
Purchaser or Transferee (Print First, Middle, Last Name)
Purchaser or Transferee’s Pistol Permit, Eligibility
Certificate, Police ID or FFL #
Purchaser or Transferee’s Address (No., Street, City/Town, ZIP Code)
Seller or Transferor’s (Print First, Middle, Last Name)
Seller or Transferor’s Pistol Permit, Eligibility Certificate,
Police ID or FFL #
Date of Birth
Seller or Transferor’s Address (No., Street, City/Town, ZIP Code)
Signature of Seller or Transferor
Signature of Purchaser or Transferee
Seller, obtain authorization number by calling (860) 685-8400. Retain the original copy for your records, give one copy to the purchaser as a
receipt, submit one copy to the local police authority where the purchaser resides, and submit a final copy to the Department of Emergency
Services and Public Protection, Special Licensing and Firearms Unit, 1111 Country Club Road, Middletown, Connecticut 06457-2389.
DPS-3-C (Rev. 10/01/19) * “Other” refers to frames, receivers, NFA weapons, etc. See instructions for Question 18 on ATF form 4473
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Sale or Transfer of All Firearms (State of ConnecticutDepartment of Administrative Services)

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Completed 13 August 2020

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