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

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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)

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