Personal Information

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Driver License OR Valid Government Issued ID

Residence Information

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21.a. Are you the actual transferee/buyer of the firearm(s) listed on this form?

Warning: You are not the actual transferee/buyer if you are acquiring any of the firearm(s) on behalf of another person. If you are not the actual transferee/buyer, the licensee cannot transfer any of the firearm(s) to you.

Are you picking up a repaired firearm(s) for another person?

21.b. Do you intend to sell or otherwise dispose of any firearm listed on this form and any continuation sheet(s) in furtherance of any felony or other offense punishable by imprisonment for a term of more than one year, a Federal crime of terrorism, or a drug trafficking offense?

21.c. Are you under indictment or information in any court for a felony, or any other crime for which the judge could imprison you for more than one year, or are you a current member of the military who has been charged with violation(s) of the Uniform Code of Military Justice and whose charge(s) have been referred to a general court-martial?

21.d. Have you ever been convicted in any court, including a military court, of a felony, or any other crime for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation?

21.e. Are you a fugitive from justice?

21.f. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?

Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.

21.g. Have you ever been adjudicated as a mental defective OR have you ever been committed to a mental institution?

21.h. Have you ever been discharged from the Armed Forces under dishonorable conditions?

21.i. Are you subject to a court order, including a Military Protection Order issued by a military judge or magistrate, restraining you from harassing, stalking, or threatening your child or an intimate partner or child of such partner?

21.j. Have you ever been convicted in any court of a misdemeanor crime of domestic violence, or are you or have you ever been a member of the military and been convicted of a crime that included, as an element, the use of force against a person as identified in the instructions?

21.k. Have you ever renounced your United States citizenship?

21.l. Are you an alien illegally or unlawfully in the United States?

21.m.1. Are you an alien who has been admitted to the United States under a nonimmigrant visa?

21.m.2. If you answered “Yes” to question 21.m.1, do you fall within any of the exceptions stated in the instructions?

21.n. Do you intend to sell or dispose of any firearm(s) listed on this form or any continuation sheet(s) to any person described in questions 21(b)-(l) or to a person described in question 21.m.1 who does not fall within a nonimmigrant alien exception.

Please answer the following question if you plan to purchase a pistol, revolver, or semiautomatic assault rifle.

Do you certify you are eligible to possess a pistol, revolver, and/or semiautomatic assault rifle under RCW 9.41.040 and 9.41.045?

This portal is for entering only necessary information for a firearms background check in Washington State. Use of this system constitutes your permission for WSP to use your personally identifiable information (PII) for the purposes of a firearm background check only.

By entering your PII into this portal, you are consenting to the Washington State Patrol (WSP) saving it for use in auto populating data fields within the Secure Automated Firearms E-Check (SAFE) system. This information will be used to conduct the required firearm background check should you decide to purchase, transfer, pre-pawn check or redeem from pawn any firearm in Washington State.

Once you have clicked ‘submit’, an eight (8) character code will be generated for you to provide to a firearm dealer for them to use in completing the firearm background check SAFE entry form. The code is only used to populate the PII data fields corresponding with Section B of the ATF Form 4473 within SAFE at the time of the firearm purchase/transfer. If you discover you made a mistake after clicking ‘submit’, you will need to complete a new application and obtain a new eight (8) character code.

This information will be retained by WSP within the SAFE system for 30 days or until the eight (8) character code is entered by the firearm dealer as part of the background check transaction, unless the background check results in a denial. In the case of ‘proceeded’ (approved) background checks, all PII will be purged in accordance with state and Federal law unless you requested for it be retained for the full 30 days below. PII for ‘denied’ background checks is retained for three (3) years, along with the reason for denial information, for appeal purposes.