Form Omb No. 1512-0551 - Certification Of Secure Gun Storage Or Safety Devices printable pdf download

Form Omb No. 1512-0551 - Certification Of Secure Gun Storage Or Safety Devices

OMB No. 1512 -0551 (11/30/2002)

DEPARTMENT OF THE TREASURY

BUREAU OF ALCOHOL, TOBACCO AND FIREARMS

CERTIFICATION OF SECURE GUN STORAGE OR SAFETY DEVICES

(All entries must be in ink)

CERTIFICATION

As required by 18 U.S.C. 921(a), I certify that secure gun storage or safety devices will be available at any place in which

firearms are sold under the Federal Firearms License to persons who are not licensees.

The term “secure gun storage or safety device” means (A) a device that, when installed on a firearm, is designed to prevent the

firearm from being operated without first deactivating this device; (B) a device incorporated into the design of the firearm that is

designed to prevent the operation of the firearm by anyone not having access to the device; or (C) a safe, gun safe, gun case, lock

box, or other device that is designed to be or can be used to store a firearm and that is designed to be unlocked only by means of a

key, a combination, or other similar means.

APPLICANT(S) NAME AND TITLE (Print or type)

BUSINESS PREMISES ADDRESS

PRESENT FEDERAL FIREARMS LICENSE NUMBER

CERTIFICATION: Under the penalties imposed by 18 U.S.C. 924, I declare that I have examined this document and to the

best of my knowledge and belief, it is true, correct and complete.

APPLICANT’S SIGNATURE

DATE

ATF F 5300.42 (3-99)

Form Omb No. 1512-0551 - Certification Of Secure Gun Storage Or Safety Devices