Military Assault Weapon Permit Application

CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS

Military Assault Weapon Permit Application for Active Duty U.S. Military Personnel

Please complete this application by typing or printing in black ink. See reverse for instructions and fees.

New Permit Renewal Permit

Permit No:

APPLICANT INFORMATION:

Last Name

First Name

Military Rank

Military ID Number

Alias/Maiden Last Name

Alias First Name

Physical Residential Address

City

ZIP Code

State

Telephone Number

Mailing Address (if different)

City

State

ZIP Code

Date of Birth

Height

Weight

Hair Color

Eye Color

Branch of Service

Name of Base or Station

Address

City

State

ZIP Code

WEAPON INFORMATION:

Serial Number

Make

Model

Caliber

Serial Number

Make

Model

Caliber

Serial Number

Make

Model

Caliber

(Use additional sheets if necessary)

DECLARATION

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signature

Date

REQUEST FOR LIVE SCAN SERVICE

CA0349400

ORI (Code assigned by DOJ)

Entertainment Firearms Permit Application

Authorized Applicant Type

Entertainment Firearms Permit Application

Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)

Contributing Agency Information:

Department of Justice, Bureau of Firearms

Agency Authorized to Receive Criminal Record Information

01123

Mail Code (five-digit code assigned by DOJ)

P.O. Box 160367

Street Address or P.O. Box

Firearms Licensing and Permit Section

Contact Name (mandatory for all school submissions)

Sacramento

City

CA

State

95816-0367

Zip Code

(916)227-2153

Contact Telephone No .

Applicant Information:

Last Name

First Name

Middle Initia

Suffix

Alias:

Last Name

First Name

Suffix

DOB:

Sex

Male Female

Driver's License N o.

HT:

WT:

Hair Color

Eye Color

BIL

Place of Birth (State or Country)

Social Security Number

Misc. Number

Home Address

Street Address or P.O. Box

City

State

ZIP Code

Your Number:

Level of Service:

DOJ FBI

If re-submission, list original ATI number: (Must provide proof of rejection)

Employer (Additional response for agencies specified by statute):

Employer Name

Mail Code (five digit code assigned by DOJ

Street Address or P.O. Box

City

State

ZIP Code

Telephone Number (optional)

Live Scan Transaction Completed By:

Name of Operator

Date

Transmitting Agency

LSID

ATI Number

Amount Collected/Billed

Call For Fee

ORIGINAL - Live Scan Operator

SECOND COPY - Applicant

THIRD COPY (if needed) - Requesting Agency

Applicant must contact their Contributing Agency to verify the accuracy of the form required for their Live Scan submission.

CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS