OMB No. 1513-0095 (01/31201/ )4
                                                                 DEPARTMENT OF THE TREASURY
                                                    ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
     APPLICATION FOR REGISTRATION FOR TAX-FREE TRANSACTIONS UNDER 26 U.S.C. 4221
                                                                          (Firearms and Ammunition)
                                         PLEASE TYPE OR PRINT - See additional instructions  for this form.
1.  NAME OF APPLICANT  (If partnership, include name of each partner.)                                             2. APPLICANT'S EMPLOYER IDENTIFICATION
                                                                                                                   NUMBER

3.  TRADE OR BUSINESS NAME                                                                                         4.  TELEPHONE NUMBER  (Include area code)

5.  ADDRESS OF PRINCIPAL PLACE OF BUSINESS  (Number, street, city, state ,                    and ZIP Code)

6.  APPLICATION IS MADE FOR THE FOLLOWING CATEGORY OR CATEGORIES  (Check applicable boxes):
         A. SELLING FIREARMS OR AMMUNITION TAX-FREE AS THE MANUFACTURER, PRODUCER, OR IMPORTER OF THE FIRE-
             ARMS OR AMMUNITION.
         B. PURCHASING FIREARMS OR AMMUNITION TAX-FREE FOR FURTHER MANUFACTURE OR FOR RESALE TO A SECOND
             PURCHASER FOR USE BY THE SECOND PURCHASER IN FURTHER MANUFACTURE.
         C. PURCHASING FIREARMS OR AMMUNITION FOR EXPORT OR FOR RESALE TO A SECOND PURCHASER FOR EXPORT.
         D. PURCHASING FIREARMS OR AMMUNITION FOR USE AS SUPPLIES ON VESSELS AND AIRCRAFT.
         E. PURCHASING FIREARMS OR AMMUNITION BY, AND FOR THE EXCLUSIVE USE OF, A NONPROFIT EDUCATIONAL
             ORGANIZATION.
         F. PURCHASING FIREARMS OR AMMUNITION BY, AND FOR THE EXCLUSIVE USE OF,  A STATE OR LOCAL GOVERNMENT.
7.  SUPPORTING INFORMATION.  Attach to this application any additional information requested unless such information is already on file
     (see(seeitemitem8 below).8 below).
    A. ALL  APPLICANTS  - Have you ever had your application for a certificate of registry denied OR had your certificate of registry
       suspended or revoked?  Include any denial, revocation  or suspension,        of an Internal Revenue Service certificate of registry.
                          YES  (Describe the circumstances involved.)               NO.
    B. ALL  APPLICANTS - Describe your business(es), or if a State or local government entity, your functions.
    C. ALL  APPLICANTS - Describe your need for each category for which you applied for in item 6. For each category, include an estimate of
      the quantity of firearms and ammunition to be sold, purchased  or used,       within a specified period of time.  Also, indicate the types of
      customers to whom you will be selling or your uses for each category.  If you already know to whom you will be selling, you may include
      the actual names of your customers.   (Examples:  (1)  "Each year, I will sell approximately 200 firearms and 5,000 rounds of ammunition
      to  the state police for their official duties (2)  "Each";    year I plan to purchase, from Manufacturer A, approximately 100 firearms on
      which I will perform further manufacture.")
    D. BUSINESS  APPLICANT -
      (1) Identify any business subject to any manufacturers excise tax under Chapter 32 of the Internal Revenue Code (includes excise tax
      on automobiles, tires, fuels, vaccines, and recreational equipment) that you controlled in the past 2 years.  State the name, address,
      social security or employer identification number, as applicable, of each business.
      (2) Identify each person's or company's name (including other businesses), date of birth, social security or employer identification
          number, residential address  or,principal place of business, as applicable, who:
          (a)          Is a director, an officer, a partner  or the,sole proprietor.
          (b)          Owns more than 10 percent of the outstanding stock of the applicant.
          (c)          Directs the management and policies for purchasing, selling  or using, firearms or ammunition of the business.
    E. EDUCATIONAL ORGANIZATION  - Supply proof (examples:  charter or articles of incorporation) that the applicant is a(n):
      (1) Educational organization under section 170(b)(1)(A)(ii), Title 26 U.S.C.  and is exempt,     from the income tax under section 501(a), Title
          26 U.S.C.  To qualify, an organization must have  a regular faculty and curriculum and normally have a regularly enrolled body of
          pupils or students in attendance at the place where its educational activities are carried on.
      (2) School operated as an activity of an organization described in section 501(c)(3), Title 26 U.S.C., that is exempt from income tax under  ections
          501(a).
    F. ALL  APPLICANTS - Any other information that TTB requests to clarify the information requested by this application.

TTB F 5300.28  (06/2009)

8.   THE SUPPORTING INFORMATION (item 7) IS CONTAINED IN (Check applicable boxes and enter appropriate information.):
      Pages numbered ____ through ____ attached to this application.
      Information on file  with the Alcohol and Tobacco Tax and Trade Bureau as part of the application for:
Certificate of Registry Number _________________________________.           Other Application Approved by the Alcohol and Tobacco Tax and Trade Bureau:
Federal Firearms License Number ______________________________.             Type of application:  _______________________________
                                                                            Permit or license number ____________________________
The applicant incorporates this information as part of this application.  If the applicant sends any other information for this application, it is also part of this
application.
                                              9.  AFFIRMATION BY APPLICANT
I affirm that this Certificate of Registry will be used as specified in applicable provisions of laws and regulations, and I understand that
misuse of this Certifcate will lead to its revocation and/or the penalties provided by law.  I agree to maintain records in compliance with
applicable laws and regulations.  These records will be available to an authorized employee of the Alcohol and Tobacco Tax and Trade
Bureau.  Also, I agree to report to the Bureau any change in my name or principal place of business and in business ownership or control,
within 30 days of such change.  Under penalties of perjury, I declare that I have examined  this application, and to the best of my knowledge
and belief, it is true, correct, and complete.
9a.  SIGNATURE OF APPLICANT OR PERSON AUTHORIZED TO SIGN FOR APPLICANT

9b.  TITLE OF APPLICANT OR PERSON AUTHORIZED TO SIGN FOR APPLICANT                                                    9c.  DATE

                                              10.  ALCOHOL AND TOBACCO TAX AND TRADE BUREAU APPROVAL
            The applicant's application is approved and a Certificate of Registry is issued under the number shown.  This certificate is valid
FOR         only for the categories identified in the registration number (see instruction 3).
            NAME                              EMPLOYER ID NUMBER                                           REGISTRATION NUMBER
TTB

USE         This certificate is not transferable to another person.  Also, this certificate may become void as a result of a change in business ownership
            or control.
ONLY        10a.  SIGNATURE AND TITLE OF TTB OFFICIAL                                                                 10b.  DATE

                                                                                                                          TTB F 5300.28  (06/2009)

                                                   INSTRUCTIONS FOR TTB F 5300.28

1. HOW TO APPLY.  Follow all the instructions on this form and
complete this application in duplicate including additional                         4. HOW TO CHANGE CATEGORIES ON APPROVED CERTIFI-
information (see item 7 on the application).  An incomplete                         CATES.  If you want to add or drop a category listed in item 6,
application causes delay, and you may not receive a Certificate of                  send your current cetificate and a new, complete application to
Registry.                                                                           the TTB office (see instruction 2).  Changes are effective when
                                                                                    TTB approves the application.
2. WHERE TO APPLY.  Send both copies of the application to:
                                                                                    5. HOW TO CHANGE YOUR NAME OR PRINCIPAL PLACE OF
State of Your                                                                       BUSINESS.  Send a letter to report any change in your name or
Principal Place                                                                     principal place of  business to the TTB office (see instruction 2)
of Business OR                 Office to contact:                                   within 30 days.  Include your registration number.
Residence:                     TTB
                                                                                    6. HOW TO REPORT CHANGES IN BUSINESS OWNERSHIP OR
All states and DC              National Revenue Center                              CONTROL.  Send a letter to report any change in business
                               550 Main St, Ste 8002                                ownership or control to the TTB office (see instruction 2) within
                               Cincinnati, OH  45202-5215                           30 days.  Include your registration number and the details of the
                               513-684-3817 or 877-882-3277                         change.
PR or VI                                           Director, Puerto Rico Operations 7. HOW TO CANCEL YOUR CERTIFICATE.  Send your approved
                               Ste 310 Torre Chardon                                certificates along with a written request to the TTB office (see
                               350 Carlos Chardon Ave                               instruction 2).
                               San Juan, PR  00918    -2124
                               787-766-5584                                         8. APPROVAL.  When TTB approves the application in item 10, TTB
                                                                                    will send one copy to the applicant.
3. REGISTRATION NUMBER AND AUTHORIZED CATEGORIES.
The letter(s) after the first six numbers in the registration number
and before the dash represents the authorized category.  Each
letter corresponds to a category listed in item 6 on the form.

                                                          PRIVACY ACT INFORMATION
The following information is provided pursuant to Section 3 of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)):
1. AUTHORITY.  Solicitation of this information is authorized pursuant to 26 U.S.C. 4222.  Disclosure of this information is mandatory, if the
applicant wishes to obtain a registration to sell or purchase firearms or ammunition tax-free.
2. PURPOSE.  To determine the eligibility of the applicant to obtain a registration to sell or purchase firearms or ammunition tax-free.
3. ROUTINE USES.  TTB will use the information to make the determination set forth in paragraph 2.  In addition, the information may be
disclosed to other Federal, State, foreign  and,local law enforcement and regulatory agency personnel to verify the information on the
application where such disclosure is not prohibited by law.  The information may further be disclosed to the Justice Department if it
appears that the furnishing of false information may constitute a violation of Federal law.  The name, address, registration number  and       ,
registration status of each person who is registered may be disclosed to permit the effective administration of the excise tax.  Finally, the
information may be disclosed to members of the public in order to verify the information on the application where such disclosure is not
prohibited by law.
4. EFFECTS OF NOT SUPPLYING REQUESTED INFORMATION.  Failure to supply complete information will delay processing and may
result in denial of the application.
The following information is provided pursuant to Section 7(b) of the Privacy Act of 1974:  Disclosure of the individual's social security
number is voluntary.  Pursuant to the statutes above, TTB is authorized to solicit this information.  The number may be used to verify the
individual's identity.
                                                      PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995.  The information collected is used to determine the eligibility of the
applicant to sell or purchase firearms and ammunition tax-free.  The information requested is required to obtain a benefit and is mandatory
by statute (26 U.S.C. 4222).
The estimated average burden associated with this collection of information is 3 hours per respondent depending upon individual circum-
stances.  Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the
Reports Management Office, Regulations and Rulings         Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC  20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB  
control number.

                                                                                                                                TTB F 5300.28  (06/2009)