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Are you the actual transferee/buyer of the firearm(s)?*

Are you under indictment or information in any court for a misdemeanor, felony, or any other crime for which the judge could imprison you?*

Have you ever been convicted in any court of 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?*

Are you subject to a court ordered restraining order or Personal Protection Order?*

Have you ever been adjudicated as mentally defective OR have you ever been committed to a mental institution*

Have you ever been discharged from the armed forces/military under dishonorable conditions? *

Are you a user of and/or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance? *

How many permits do you need?*

By signing electronically below I understand that the answers above are true and correct. I understand that answering YES to question #1 when I am not the actual buyer is a crime punishable by Felony. I understand that a person who answers YES to questions #2-9 may be prohibited from purchasing or receiving a firearm. I also understand that making any false statement (oral or written) or exhibiting any false or misrepresented identification with respect to this transaction is also a crime punishable as a Felony. I further understand that the repetitive purchase for the purpose of resale for livelihood and profit without a federal firearms license is a violation of law.

Electronic Signature Agreement

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I agree.

Any special instructions for the Clerk?

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