This is not a completely valid representation of Form 4437 (Firearms Transaction Record). This is a set-up to represent the demo for PDF Stamper.
Stamp PDF
ATF-4473-Stamped.pdf
 11-19-2023 04:11 AM
Section A
Must Be Completed By Transferor/Seller Before Transferee/Buyer Completes Section B
Manufacturer and Importer (if any)
(If the manufacturer and importer are
different, include both.)		 Model
(if designated)		 Serial Number Type Caliber or Gauge
FN Herstal FN SCAR-17 ABC123 Heavy Rifle 7.62x51
 
 
 
One  
  1
   
Section B
Must Be Completed Personally By Transferee/Buyer
Shrader
Dylan
T
17 Glenmere Lane
Coram
NY
11776
Suffolk
Coram, New york
N/A
5
10
170
Male
07-11-1997
678945123
N/A
Not Hispanic or Latino
White
United States of America (U.S.A)
 
Section B.21
Answer the following questions by selecting yes” or “no” in the dropdown to the right of the questions:
Are you the actual transferee/buyer of the firearm(s) listed on this form and any continuation sheet(s) (ATF Form 5300.9A)?
Warning: You are not the actual transferee/buyer if you are acquiring the firearm(s) on behalf of another person. If you are
not the actual transferee/buyer, the licensee cannot transfer the firearm(s) to you. Exception: If you are only picking up a repaired
firearm(s) for another person, you are not required to answer 21.a. and may proceed to question 21.b.		 Yes
Are you under indictment or information in any court for a felony, or any other crime for which the judge could imprison you for more
than one year, or are you a current member of the military who has been charged with violation(s) of the Uniform Code of Military
Justice and whose charge(s) have been referred to a general court-martial?		 No
Have you ever been convicted in any court, including a military 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?		 No
Are you a fugitive from justice? No
Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized
for medicinal or recreational purposes in the state where you reside.		 No
Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution? No
Have you ever been discharged from the Armed Forces under dishonorable conditions? No
Are you subject to a court order, including a Military Protection Order issued by a military judge or magistrate, restraining you from
harassing, stalking, or threatening your child or an intimate partner or child of such partner?		 No
Have you ever been convicted in any court of a misdemeanor crime of domestic violence, or are you or have you ever been a member of
the military and been convicted of a crime that included, as an element, the use of force against a person as identified in the instructions?		 No
Have you ever renounced your United States citizenship? No
Are you an alien illegally or unlawfully in the United States? No
Are you an alien who has been admitted to the United States under a nonimmigrant visa? No
If you are such an alien do you fall within any of the exceptions stated in the instructions? (U.S. citizens/nationals leave this blank) No
1234567
Section C
Must Be Completed By Transferor/Seller Prior To The Transfer Of The Firearm(s)
Juiced Note: Section D (NICS fields) has been dropped for convenience.
 
Section E
Must Be Completed By Transferor/Seller
 
Created on Feb. 25, 2022 at  2:33 PM (EST). Last updated by qbtools on Nov. 19, 2023 at  4:11 AM (EST). Owned by Downard, Dylan.
Dylan Downard
qbtools
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