To: HAWAI‘I POLICE DEPARTMENT

Subject: SALE/TRANSFER OF RIFLE/SHOTGUN

Pursuant to Sec. 134-2(f) Hawaii Revised Statutes (as amended 1994), you are hereby informed of the following transaction:

Buyer/Transferee's Name:__________________________________________________________

Address:__________________________________________________________________________

Permit to Acquire #:_________________________ Expiration Date:_____/_____/________

Make:____________________ Model:_____________________ Caliber:____________________

Type of Action:_____________________ Serial #:____________________________________

 

___________________________

___________________________

_____/_____/________

Print Name of Seller/Transferor

Signature of Seller/Transferor

Date

 

VENDOR/TRANSFEROR SHALL SIGN IN INK AND DELIVER TO THE POLICE STATION PERSONALLY OR BY REGISTERED MAIL WITHIN 48 HOURS.

 

Rev. 02/2011