Atf E-Form 5400.5 - Report Of Theft Or Loss - Explosive Materials

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OMB No. 1140-0026 (04/30/2012)

U.S. Department of Justice

Bureau of Alcohol, Tobacco, Firearms and Explosives

Report of Theft or Loss - Explosive Materials

For ATF Use Only

Date Received

Date Faxed to JSOC & Field Division

Unique Identifier

Case Number

To Be Completed By Person Making Report

Upon discovery of any theft or loss of any of your explosive materials:

- First, contact ATF toll free at 1-800-461-8841 between 8:00 a.m. - 5:00 p.m. EST or after hours and weekends contact ATF at 1-800-800-3855 to report

the theft or loss;

- Second, contact your local law enforcement office to report the theft or loss to obtain a police report; and

- Third, complete this form and attach any additional reports, sheets or invoices necessary to provide the required information, and fax the form with

additional material(s) to the ATF U.S. Bomb Data Center (USBDC) at 866-927-4570.

2. Type of Report (Check one):

1. Date

Theft

Loss

Supplement

3. Full Name of Person Making the Report (Last, First, Middle)

4. Corporate or Business Name (If applicable)

5a. Office Address (Street Address, City, State, and Zip Code)

5b. Telephone Number

6. Actual Location of Theft or Loss (if different from item 5a)

8. Name of Local Law Enforcement Officer to Whom Reported