FIREARMSREGISTRATION

PRIVACYACTSTATEMENT

AUTHORITY: 10USC8013;GunControlActof1968(18U.S.C.922(d)(9)and(g)(9)1LautenbergAmendment);44U.S.C.3101;andEO9397.

PRJVACYACT-1974asAmendedapplies: Thismemomaycontaininformationwhichmustbeprotected1AWDoDD5400.11,anditisForOfficialUseOnly(FOUO).

PRINCIPALPURPOSE:Torecord personalinformationonanindividualwhoregistersandstoreshisorherprivately-ownedfirearmonanAirForceinstallationorfacility. Tomaintainaccountabilityoffirearms,recordedwhenfirearmsareremovedandreturnedtothefacility,anddeterminethenumbersandlocationofprivately-ownedfirearmsonaninstallation.

ROUTJNEUSES: Informationmaybedisclosedtolocal,county,stateandfederallawenforcement/investigativeauthoritiesforinvestigationpurpose.SSNusedforidentificationandretrievingfromfiles.

DISCLOSUREISVOLUNTARY: FailuretodisclosetheinformationtoincludeSSNwillresultintheindividualnotbeingabletoregisterorstorefirearmsontheinstallationorfacility.Attempttokeepfirearmsonbasethatarenotproperlyregisteredandstoredcouldresultinconfiscationofthefirearms.

disciplinaryaction,orboth.

NAME(LastFirst,Ml)GRADE/RANKSSN

ZATIONIDUTYPHONE

ORGANI

FIRE-WEAPONTYPEMAKECALIBERSERIALRECEIPTFORFIREARMSNOTRETAINEDBYOWNER

ARM(Rifle,Shotgun, (Manufacture)ORNUMBER

NO.

1

2

3

4

etc.)

GAUGE

DATERECEIVEDSIGNATUREOFSUPPLYCLERK

5

HAVEYOUBEENCONVICTEDOFADOMESTICVIOLENCECRIMEINVIOLATIONOFTHEGUNCONTROLACT/LAUTENBERGAMENDMENT?YESI IINOiDIDYOURECEIVETHEGUNCONTROLACTANDLAUTENBERGAMENDMENTBRIEFING? YES!IINOi

OWNER,ATTACH A COPY OF DOFORM2760, QUALIFICATIONTOPOSSESSFIREARMSANDAMMUNITION.IHAVEREADANDWillCOMPLYWJTHAFI31-101,Aft31207AHOSUPPLEMENTSTHERETOANDDOFORM2780.

SIGNATUREOFOWNERDATE:STORAGELOCATION/ADDRESS

IRETAINPOSSESSIONOFABOVEFIREARM(S):

0STOREFIREARM (S)IN;ANDWITHDRAWSAME:

DTEMPORARILYSTOREIN:PENDINGDISPOSITION:

WASTHEANNUALGUNCONTROLACTOF1968/LAUTENBERGAMENDMENTBRIEFEDTOFIREARMOWNERBYUNITCOMMANDER?YESCINOi

TYPE NAME,GRADEANDRANKOF UNITCOMMANDERORDESIGNEESIGNATUREOFUNITCOMMANDERORDESIGNEEDATE:

TYPENAME,GRAOEANDRANKOFSTORINGUNITCOMMANDERORDESIGNEE SIGNATUREOFSTORINGUNITCOMMANDERORDESIGNEEDATE:

RECORDOFTEMPORARYWITHDRAWALSBYOWNERANDRETURNTOSTORAGE

FIRE-TEMPORARY WITHDRAWALSRETURNTOSTORAGE

ARMMAKE

NO.(Manufacture)DATESIGNATUREOFOWNERDATESIGNATUREOFDESIGNATEDCUSTODIAN

.

AFIMT1314,20051017,V1PREVIOUSEDITIONSAREOBSOLETE.

QUALIFICATIONTOPOSSESSFIREARMSORAMMUNITION

AUTHORITY: 18U.S.C.922(g)(9);E.O.9397.

PRIVACYACTSTATEMENT

PRINCIPALPURPOSE(S): Toobtaininformationtodetermineifyouhavebeen convictedofacrimeofdomesticviolencewhichwould

disqualifyyoufromshipping,transporting,possessingorreceivingeitherGovernment-issuedorprivatefirearmsorammunitionandtodetermineifreassignment,reclassification,detailorotheradministrativeactioniswarranted.YourSocialSecurityNumberissolicitedsolelyforpurposesofverifyingyouridentity.

ROUTINEUSE(S):TotheDepartmentofJusticesothatsuchinformationcan beincludedintheNationalInstantCriminalBack.groundCheck.Systemwhichmaybeusedby firearmlicensees(importers,manufacturersordealers)todeterminewhetherindividualsarequalifiedtoreceiveorpossess firearmsandammunition.

DISCLOSURE:Mandatoryforallpersonnelwhoarerequiredtocertify.Failuretoprovidetheinformationmayresultin(1)(militaryonly)theimpositionofcriminaloradministrativepenaltiesforfailingtoobeyalawfulorder,and(2)(civilianonly)theimpositionofadministrativepenalties,toincluderemovalfromFederalservice.However,neitheryouranswersnorinformationorevidencegainedbyreasonofyouranswerscanbeusedagainstyouinanycriminalprosecutionforaviolationofTitle18,UnitedStatesCode,Section922(g)l9),including(militaryonly)prosecutionsundertheUniformCodeofMilitaryJustce,basedonaviolationofSection922(g)(9),forconductwhichoccurredpriortothecompletionofthisform.Theanswersyoufurnishandanyinformationresultingtherefrom,however,maybeusedagainstyouinacriminaloradministrativeproceedingsifyouknowinglyandwillfullyprovidefalsestatementsorinformation.

SECTIONI-INSTRUCTIONS

AnamendmenttotheGunControlActof1968(18U.S.C.(c)apersonwhowascohabitingwithor hascohabitedwiththa922)makesitafelonyforanyonewhohasbeenconvictedof victimasaspouse,parent,orguardian,or

amisdemeanorcrimeofdomesticviolencetoship,transport,(d)apersonwhowassimilarlysituatedtoaspouse,parent,orpossess,orreceivefirearmsorammunition.Itisalsoafelonyfor guardianofthevictim;

anypersontosellorotherwise disposeofafirearmtoanyperson

soconvicted.(4)theconvictedoffenderwasrepresentedbycounsel,orknowinglyandintelligentlywaivedtherighttocounsel;

TheDepartmentofDefensehas,bypolicy,expandedthe

prohibitionscontainedinTitle18Section922(g)(9)tothose(5)ifentitledtohavethecasetriedbyjury,thecasewasactuallytriedmilitaryorcivilianpersonnelwhohavefelonyconvictionsfor byjuryorthepersonknowingly andintelligently waivedtherighttocrimesofdomesticviolence.Convictionsofcrimesofdomestic havethecasetriedbyjury;

violencedonotincludesummarycourt-martialconvictions,the

impositionofnonjudicialpunishment(Article15,UCMJ),or(6)theconvictionhasnotbeenexpungedorsetaside,ortheconvicteddeferredprosecutions(orsimilaralternativedispositions)incivilian offenderhasnotbeenpardonedfortheoffenseorhadcivilrightscourts.Furthermore,apersonshallnotbeconsideredashaving restored,unlessthepardon,expungement,orrestorationofcivilcommineda"crimeofdomesticviolence"forpurposesofthe rightsprovidesthatthepersonmaynotship,transport,possessorfirearmsrestrictionoftheGunControlActunlessallofthe receivefirearms.

followingelementsarepresent:

Ifyouhaveeverreceivedadomesticviolenceconviction:(1)you

11)thepersonwasconvictedofacrime;maynotpossessanyfirearmorammunition;and(2)youmustreturnanyGovernment-issuedfirearmorammunitiontoyourcommanderor

12)theoffensehasasitsfactualbasistheuseorattempteduseimmediatesupervisor;and(3)youmusttakestepstorelinquish

ofphysicalforce,orthreateneduseofadeadtyweapon;possessionofanyprivatelyownedfirearmsorammunition. Furthermore,

anypreviouslyissuedauthorizationtopossessafirearmorammunitionis

(3)theconvictedoffenderwasatthetimeoftheoffense:revok.ed.

(a)acurrentorformerspouse,parentorguardianoftheIfyouhaveanyquestions,oryouareuncertainifyouhavesuchavictim, conviction,youmaywishtocontactalegalassistanceattorney,if

(b)apersonwithwhomthevictimsharedachildincommon.eligible,or aprivateanorney,atyourownexpnse.

SECTIONII-QUALIFICATIONINQUIRY(Completeandreturntoyourcommanderorimmediatesupervisorwithin10daysofreceipt)

1.HAVE YOUEVERBEENCONVICTEDOFACRIMEOFDOMESTICVIOLENCEASDESCRIBEDABOVE: (Initialanddate)

YESIDON'TKNOW(Provide

explanationonreverse)

2.IFYOUANSWERED"YES"TOTHEFIRSTQUESTION,PROVIDETHEFOLLOWINGINFORMATIONWITHRESPECTTOTHECONVICTION:

a. COURT/JURISDICTION / b.DOCKET/CASENUMBER
c.STATUTE/CHARGE / d.DATESENTENCED(YYYYMMDDJ

3.CERTIFICATION. Iherebycertifythat,tothebestofmyinformationandbelief,alloftheinformationprovidedbymeistrue,correct,complete,andmadeingoodfaith. Iunderstandthatfalseorfraudulentinformationprovidedhereinmaybegroundsforcriminaland/oradministrativeproceedings,toinclude(ifcivilian)adverseaction,uptoandincludingremoval,and(ifmilitary)disciplinaryactionundertheUniformCodeofMilitaryJustice. IfurtherunderstandthatIhaveacontinuingobligationtoinformmyCommanderorSupervisorshouldIbeconvictedofacrimeofdomesticviolenceinthefuture.

a.NAME(Last,First,MiddleInitial) / b.RANK/GRADE / c.SOCIALSECURITYNUMBER
d.ORGANIZATION / e.SIGNATURE / f.DATESIGNED
(YYYYMMDO)

DDFORM2760,DEC2002PREVIOUSEDITIONISOBSOLETE.AcklbeProfeSslonal7.0

MEMORANDUM

From:

To:ReportsandAnalysis,JBC-W

Subj:RELEASEOFINFORMATIONFORPERSONALLYOWNEDWEAPONSREGISTRATION

I,(printname)releasethefollowingpersonalinformationtocompleteregistrationofmypersonallyownedweapon(s).

DateofBirth:------

PlaceofBirth:------

Sign:_Date: ------