CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS

NEW RESIDENT HANDGUN

OWNERSHIP REPORT

Processing Fee of $19 Per Handgun 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

MAILING ADDRESS (If Different)

CITY

STATE

ZIP

ID TYPE (Circle One)

Enter your California Driver's License (CDL), California ID (CID), or Military ID (MIL)
number in the ID Number box to the right. If using your military identification you must
CDL
CID
MIL
send a copy of your permanent duty station orders stating you are stationed in California.

ID NUMBER

U.S.
CITIZEN?

DAYTIME PHONE #

YES
NO

DATE OF BIRTH
Mo

Day

If no, enter
AR# or I-94#
PLACE OF BIRTH
(State or Country)

AND Country
of Citizenship
SEX

(
RACE

EYE COLOR HAIR COLOR HEIGHT WEIGHT

Yr

B. Handgun(s) Information
SERIAL NUMBER
Type of
Handgun:

Semiauto

Revolver

Single Shot

MODEL (3032 Tomcat, KP95, 17C, etc.)

MAKE (As stamped on firearm)

Other:

CALIBER HANDGUN ORIGIN

(U.S., Italy, China, etc.) BARREL

LENGTH
IN.
CM.

DATE ACQUIRED
Mo

Day

ACQUIRED FROM:
Family Member
Yr

Firearms Dealer

Private Party

Gun Show

COLOR

Other:

(Specify relationship)

SERIAL NUMBER
Type of
Handgun:

Semiauto

MAKE (As stamped on firearm)

DATE ACQUIRED
Mo

Day

Revolver

Single Shot

MODEL (3032 Tomcat, KP95, 17C, etc.)

ACQUIRED FROM:
Family Member

CALIBER HANDGUN ORIGIN

Firearms Dealer

Private Party

(U.S., Italy, China, etc.) BARREL

Gun Show

LENGTH
IN.
CM.

COLOR

Other:

(Specify relationship)

Yr

Other:

SERIAL NUMBER
Type of
Handgun:

Semiauto

MAKE (As stamped on firearm)

DATE ACQUIRED
Mo

Day

Revolver

Single Shot

MODEL (3032 Tomcat, KP95, 17C, etc.)

ACQUIRED FROM:
Family Member
Yr

(Specify relationship)

Other:

CALIBER HANDGUN ORIGIN

Firearms Dealer

Private Party

(U.S., Italy, China, etc.)

Gun Show

BARREL LENGTH
IN.
CM.
COLOR

Other:

C. Declaration
I declare under penalty of perjury (Sections 126 and 672 PC) that all statements made by me on this application are true and complete. I
expressly authorize DOJ to perform firearms eligibility checks of all relevant state and federal databases, including the National Instant
Criminal Background Check System. I also understand that if I currently possess/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
FD 4010A (10/04)

INSTRUCTIONS ON REVERSE

DATE

California Department of Justice

Bureau of Firearms
INSTRUCTIONS FOR NEW RESIDENT
HANDGUN OWNERSHIP REPORT
Submission Requirements
Individuals must submit this application with a fee (check or money order made payable to the Department of
Justice) in the amount of $19 per handgun (e.g. 3 handguns x $19 = $57) to:
Department of Justice
Bureau of Firearms
P.O. Box 820200
Sacramento, CA 94203-0200
Complete all required information. Incomplete applications will be returned without processing. If reporting more
than three handguns, make and attach extra copies of this form to meet your reporting needs. 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 Handgun Ownership Report. Do not register long guns using this form. If
you wish to voluntarily report ownership of long guns, use the Department of Justice Firearm Ownership Record
form available at www.ag.ca.gov/firearms, or by calling (916) 263-4887.
This form may not be used to report ownership of assault weapons defined in PC section 12276, 12276.1, or
12276.5. 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.ag.ca.gov/firearms. Questions may
be directed to the Bureau of Firearms at (916) 263-4887.

Part A. Owner Information

Enter the information requested. Only one applicant per form. If using a military number for identification you must
submit a copy of your permanent duty station orders indicating you are stationed in California with this application
and the appropriate fees.

Part B. Handgun Information

For each handgun, you must provide the identification information requested. Please refer to your handgun owner
information or the samples below to assist you in providing the required information:
Serial Number

Usually located on the frame of the handgun. May be all numeric or a combination of
alpha and numeric characters.

Make

The manufacturer of the handgun (e.g., Beretta, Ruger, Glock, Smith and Wesson).

Model

The model name of the handgun (e.g., 3032 Tomcat, KP95, 17C, Mini 14).

Caliber

The caliber of the handgun (e.g., .38, .45, .308).

Handgun Origin

The country of origin of the handgun (e.g., United States, Russia, China, Italy).

Barrel Length

Enter the barrel length as stated in your owner information, or measure the barrel length
by closing the action of the handgun 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 application.