STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 042 (Rev. 07/2015) PAGE 1 of 2CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS ASSAULT WEAPON and/or .50 BMG RIFLE

Inventory, Acquisition, Disposition and Manufacture

Entry Number AW or .50 BMG Rifle Make Model Serial Number Caliber

Acquisition Type Date of Acquisition Transferor Name Transferor Type Transferor Permit Number

Disposition Type Date of Disposition Transferee/Agency Name Transferee Type Transferee Permit Number

Entry Number AW or .50 BMG RIfle Make Model Serial Number Caliber

Acquisition Type Date of Acquisition Transferor Name Transferor Type Transferor Permit Number

Disposition Type Date of Disposition Transferee/Agency Name Transferee Type Transferee Permit Number

Entry Number AW or 50 BMG Rifle Make Model Serial Number Caliber

Acquisition Type Date of Acquisition Transferor Name Transferor Type Transferor Permit Number

Disposition Type Date of Disposition Transferee/Agency Name Transferee Type Transferee Permit Number

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

Permittee Signature Date

Permit Number: Reporting Period

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STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 042 (Rev. 07/2015) PAGE 2 of 2

Assault Weapon and/or .50 BMG Rifle Inventory, Acquisition, Disposition and Manufacture

INSTRUCTIONSREQUIREMENTS: The authorized permit or license holder (permittee) must maintain current records of inventory, acquisitions, dispositions, and manufacture of assault weapons and/or .50 BMG rifles possessed and/or manufactured in California pursuant to California Code of Regulations, title 11, section 4130, subdivision (a). Current records must be maintained on form BOF 042, or a computer generated printout using the same format. (Cal. Code Regs., tit. 11, § 4130, subd. (a)(1).) The permittee must make these records available to any peace officer or other persons designated by the Attorney General upon request. (Cal. Code Regs., tit. 11, § 4130, subd (h).) The permittee must also submit to the Department of Justice (DOJ) an annual report of inventory, acquisitions, dispositions, and manufacture of assault weapons and/or .50 BMG rifles possessed and/or manufactured in California. The annual report shall list all assault weapons and/or .50 BMG rifles possessed by the permittee at any time during the reporting term. All acquisitions, dispositions, manufacture, lost or stolen assault weapons and/or .50 BMG rifles, and all assault weapons and/or .50 BMG rifles in continued possession from the prior permit term must be reported. The annual report must be submitted to DOJ with the Annual Dangerous Weapons License/Permit(s) Renewal Application, form BOF 031. Or, upon termination of the permit, a final report detailing all remaining unreported activities must be submitted to DOJ. Completing the Assault Weapon and/or .50 BMG Rifles Report form: This form allows you to report up to three separate weapons. Make as many copies of this form as required to complete the reporting requirement. Place a sequential entry number in the indicated space for each reported activity. Please complete the following fields for all entries: - Entry Number - Transferee/Agency Name & Type - Weapon Type (AW or .50 BMG) - Transferee Permit Number - Make, Model, Serial & Caliber (Assault Weapon Permit, Out-of-State FFL, or - Acquisition Type & Date Peace Officer Purchaser's Employer Agency Name) - Transferor Name & Type - Permittee Signature and Date - Transferor Permit Number - Dangerous Weapons Permit Number (Dangerous Weapon Permit, Out-of-State FFL, - Reporting Period Dates or Assault Weapon Permit) - Current Page Number - Disposition Type & Date - Total Number of Pages If you have any questions, please contact the Firearms Licensing and Permits Section (FLPS) at (916) 227-2153. Department of Justice

Bureau of Firearms - FLPS P.O. Box 160367

Sacrament16-0367