Mendocino — BOF 4546

Source: https://oag.ca.gov/system/files/media/bof-4546.pdf

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 4546 (Rev. 12/2019) PAGE 1 of 4 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS Notice of No Longer in Possession (Pen. Code § 28000) DOJ/BOF Case No.: Handgun/Long Gun Assault Weapon/.50 BMG RifleCheck appropriate box: (complete sections A,B,D,E) (complete sections A,C,D,E) A. Owner Information Last Name First Name Middle Name Date of Birth

Residence Street Address City State Zip Code

Mailing Address (if different) City State Zip Code

CA DL, ID, or Military ID No. Telephone Number Is the owner deceased? Date of Death County of Death Yes No

B. Handgun/Long Gun Information Date Purchased/Acquired Serial Number If Handgun: If Long Gun: Semi-auto Revolver Single Shot Other Rifle Shotgun

Make (as stamped on firearm) Model (3032 Tomcat, KP95, 17C) Caliber Firearm Origin (US, Italy, China) Barrel Length

C. Assault Weapon/.50 BMG Rifle Information - Voluntary cancellation of registration (Cal. Code Reg., tit. 11, § 5473) AWR/.50 BMG Registration No. Serial Number Make (as stamped on firearm) Model (e.g., AK47, AR15, TEC 9) Caliber

D. Disposition (see detailed instructions on reverse) Seized by or surrendered to law enforcement agency - law enforcement agency name and signature required: Law enforcement agency: Report No.: and/or agent or representative: Signature: SIGN Date: Reported to law enforcement as: Lost Stolen Report No.: Date: Sold/transferred to a licensed firearms dealer: Dealer name: Date:

Dealer address:
Sold/transferred to a family member or private party: Transferee name: Transfer date:

Transferee address: Transferee telephone: Firearms Ownership Record/Operation of Law/Intra familial transfer submitted Copy of completed form or DOJ acknowledgement letter attached Verification (i.e. insurance claim) Verified destroyed: Destruction method: Destruction date: attached. No longer resident of California: New state/country of residence: Date residency established:

Copy of government issued identification attached from new state/country of residence

Transferred firearms to person/dealer in another state: Transferee name: Transfer date:

Transferee address: Transferee telephone:
Documentation of sale/transfer attached Federal Firearms License No. (if applicable):

Returned to dealer/manufacturer: Dealer/manufacturer name: Return date: Dealer/manufacturer address: Documentation from manufacturer attached

E. Declaration I declare under penalty of perjury under the laws of the State of California the forgoing is true and correct. Signature: SIGN Date:

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 4546 (Rev. 12/2019) Notice of No Longer in Possession PAGE 2 of 4 Completion Instructions Type of Firearm Check the appropriate box. Use one form per firearm. For additional firearm(s), please use the included supplemental page and make as many copies as necessary. Section A - Owner Information Enter the requested information. If you are submitting this form for a deceased person, check "yes," and list the date and county of death. To expedite processing of your request, please include a copy of the death certificate with this form. Section B - Handgun/Long Gun Information Complete this section if you checked the Handgun/Long Gun box. Do not complete this section if you checked the Assault Weapon/.50 BMG Rifle box and entered firearm information in Section C. Section C - Assault Weapon/.50 BMG Rifle Information Complete this section if the firearm is a registered Assault Weapon/.50 BMG Rifle. Do not complete this section if you checked the Handgun/Long Gun box and entered firearm information in Section B. Completion of Section C will result in the cancellation of the registration of the Assault Weapon/.50 BMG Rifle. Section D - Disposition Check the appropriate box and complete the required information. • If you check "Seized by or surrendered to law enforcement agency," an agent or representative from the listed law enforcement agency must verify and enter the requested information, sign, and date this form. Attach a copy of a police report or written confirmation from the agency. • If you check "Reported to law enforcement" as "Lost" or "Stolen," enter the number and date of the police report and attach a copy of the report or written confirmation from the agency. • If you check "Sold/transferred to a licensed firearms dealer," list the name and address of the licensed California firearms dealer who conducted the sale or transfer, and the date of the sale or transfer. • If you check "Sold/transferred to a family member or private party," list the name, address and telephone number of the person who purchased/obtained the firearm and the date of the sale or transfer. (NOTE: As of 01/01/1991, a sale or transfer must be completed through a licensed firearms dealer when neither party involved in the sale or transfer of a firearm has a dealer's license issued pursuant to Penal Code section 26700.) The Department of Justice (DOJ) will not process this form until and unless DOJ receives either a Dealer's Record of Sale (documenting a sale of a firearm through a dealer), a Firearms Ownership Record, an Operation of Law/Intra-familial Transfer submitted by the person who purchased/ obtained the firearm (i.e transfers between immediate family members pursuant to Penal Code section 27870) or a DOJ acknowledgement letter to document the sale or transfer. (Pen. Code, § 27545) • If you check "Verified destroyed," list the date and method of destruction. You must also attach written verification of the destruction (i.e. copy of an insurance claim for the destroyed firearm or statement from gunsmith or manufacturer stating that the firearm was not repairable and could not be made operable). • If you check "No longer a resident of California," list the date that you established residency in a state outside of California or country outside of the United States. You must also attach a legible copy of your government issued identification from the other state or country. • If you check "Transferred firearm out of state," list the name and address of the person who purchased/obtained the firearm and the date of the sale or transfer, and the name, address, telephone number and, if known, the Federal Firearms License (FFL) number of the firearms dealer(s) who conducted the sale/transfer. You must also attach any relevant documentation of the sale or transfer, such as a sales receipt. • If you check "Returned to dealer/manufacturer," list the name and address of the manufacturer. You must also attach documentation showing that the dealer/manufacturer received the firearm from you and did not redeliver it to you. Part E - Declaration You must read, sign and date the declaration. NOTE: The DOJ may not be able to disassociate you from the listed firearm(s) without adequate supporting documentation (i.e., police reports, dealer transfer information, details of transfer to private party). Mail completed Notice of No Longer in Possession and copies of any required documents to: Department of Justice Bureau of Firearms P.O. Box 820200 Sacramento, CA 94203-0200 For questions, please visit the Bureau of Firearms website at www.oag.ca.gov/firearms

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 4546 (Rev. 12/2019) PAGE 3 of 4 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS Notice of No Longer in Possession Supplement Page Supplement Page.: DOJ/BOF Case No.: Handgun/Long Gun Assault Weapon/.50 BMG RifleCheck appropriate box: (complete sections A,B,D,E) (complete sections A,C,D,E) A. Owner Information Last Name First Name Middle Name Date of Birth

Residence Street Address City State Zip Code

Mailing Address (if different) City State Zip Code

CA DL, ID, or Military ID No. Telephone Number Is the owner deceased? Date of Death County of Death Yes No

B. Handgun/Long Gun Information Date Purchased/Acquired Serial Number If Handgun: If Long Gun: Semi-auto Revolver Single Shot Other Rifle Shotgun

Make (as stamped on firearm) Model (3032 Tomcat, KP95, 17C) Caliber Firearm Origin (US, Italy, China) Barrel Length

C. Assault Weapon/.50 BMG Rifle Information - Voluntary cancellation of registration (Cal. Code Reg., tit. 11, § 5473) AWR/.50 BMG Registration No. Serial Number Make (as stamped on firearm) Model (e.g., AK47, AR15, TEC 9) Caliber

D. Disposition (see detailed instructions on reverse) Seized by or surrendered to law enforcement agency - law enforcement agency name and signature required:

Law enforcement agency: Report No.:

and/or agent or representative: Signature: SIGN Date:

Reported to law enforcement as: Lost Stolen Report No.: Date: Sold/transferred to a licensed firearms dealer: Dealer name: Date:

Dealer address:
Sold/transferred to a family member or private party: Transferee name: Transfer date:

Transferee address: Transferee telephone: Firearms Ownership Record/Operation of Law/Intra familial transfer submitted Copy of completed form or DOJ acknowledgement letter attached Verification (i.e. insurance claim) Verified destroyed: Destruction method: Destruction date: attached No longer resident of California: New state/country of residence: Date residency established:

Copy of government issued identification attached from new state/country of residence

Transferred firearms to person/dealer in another state: Transferee name: Transfer date:

Transferee address: Transferee telephone:
Documentation of sale/transfer attached Federal Firearms License No. (if applicable):

Returned to dealer/manufacturer: Dealer/manufacturer name: Return date: Dealer/manufacturer address: Documentation from manufacturer attached E. Declaration I declare under penalty of perjury under the laws of the State of California the forgoing is true and correct. Signature: SIGN Date:

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 4546 (Rev. 12/2019) PAGE 4 of 4 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS Notice of No Longer in Possession

Privacy Notice As Required by Civil Code § 1798.17

Collection and Use of Personal Information: The Division of Law Enforcement, Bureau of Firearms in the Department of Justice collects the information on this notice pursuant to Penal Code section 28000. The Bureau of Firearms uses this information to record a notice that a person is no longer in possession of a firearm. In addition, any personal information collected by state agencies is subject to the limitations in the Information Practices Act and state policy. The Department of Justice's general privacy policy is available at http://oag.ca.gov/privacy-policy.

Providing Personal Information: All personal information on this notice is mandatory. Failure to provide the mandatory personal information will result in your notice not being processed.

Access to Your Information: You may review the records maintained by the Division of Law Enforcement, Bureau of Firearms in the Department of Justice that contain your personal information, as permitted by the Information Practices Act. See below for contact information.

Possible Disclosure of Personal Information: In order to record a notice that a person is no longer in possession of a firearm, we may need to share the information you provide us with any Bureau of Firearms representative or any other person designated by the Attorney General upon request. The information you provide may also be disclosed in the following circumstances:

■ With other persons or agencies when necessary to perform their legal duties, and their use of information is compatible and complies with state law, such as for investigations, licensing, certification, or regulatory purposes;

■ To another government agency as required by state or federal law.

Contact Information: For questions about this notice or access to your records, you may contact the Staff Services Analyst in the Customer Support Center at (916) 210-2300, via email at firearms.bureau@doj.ca.gov, or by mail at P.O. Box 820200, Sacramento, CA 94203-0200.