STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 043 (Rev. 07/2015) PAGE 1 of 2CALIFORNIA DEPARTMENT OF JUSTICE

BUREAU OF FIREARMS SHORT-BARRELED SHOTGUN/RIFLE

Inventory, Acquisition, Disposition and Manufacture

Entry Number Shotgun or 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 Shotgun or 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 Shotgun or 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 043 (Rev. 07/2015) PAGE 2 of 2

Short-Barreled Shotgun/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 short-barreled shotguns/rifles possessed and/or manufactured in California pursuant to the California Code of Regulations, title 11, section 4130, subdivision (a). Current records must be maintained on form BOF 043, 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 short-barreled shotguns/rifles possessed and/or manufactured in California. The annual report shall list all short-barreled shotguns/rifles possessed by the permittee at any time during the reporting term. All acquisitions, dispositions, manufacture, lost or stolen short-barreled shotguns/rifles, and all short-barreled shotguns/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 Short-Barreled Shotgun/Rifle 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 Name & Type - Weapon Type (Shotgun or Rifle) - Transferee Permit Number - Make, Model, Serial & Caliber (Dangerous Weapon Permit or Transferee's Rank) - Acquisition Type & Date - Permittee Signature and Date - Transferor Name & Type - Dangerous Weapons Permit Number - Transferor Permit Number - Reporting Period Dates (Dangerous Weapon Permit or Out-of-State FFL) - Current Page Numbers - 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

Sacramento, CA 95816-0367