{1}
##LOC[OK]##
{1}
##LOC[OK]##
##LOC[Cancel]##
{1}
##LOC[OK]##
##LOC[Cancel]##
Firearm Registration Refusal Form
Business Name
Business Address
Contact Number
Email Address
Federal Firearm Lic. #
Rejected Buyer Name
Date of Birth
June, 2019
June, 2019
S
M
T
W
T
F
S
22
26
27
28
29
30
31
1
23
2
3
4
5
6
7
8
24
9
10
11
12
13
14
15
25
16
17
18
19
20
21
22
26
23
24
25
26
27
28
29
27
30
1
2
3
4
5
6
Race
Please select
Asian
Black
Hispanic
Middle Easterner/Arabic
Native American
Other
Pacific Islander
Unknown
White
Sex
Please select
Male
Female
Driver's Lic. #
Address
Make of Firearm
Model of Firearm
Caliber of Firearm
Submitting Employee