U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
Application for Explosives License or Permit
Section A (Must be completed by all applicants.) Please print all information in block letters.
1. Name of Applicant (If partnership, include name of each partner)
2. Trade Name or Business Name, if any
3. Employer Identification Number (EIN) or Social
Security Number (SSN) (Voluntary-see Privacy Act
Information)
4. Name of County in Which
Business is Located
5a. Premises Address (No., Street, City, State, Zip Code)
6. Location (If no street address listed in Item 5a, provide directions and
distance from nearest post office or city limits)
7. Telephone Number (Include Area Code)
Business ( )
8. Are you presently engaged in a business and/or operations for which a license or permit is required under 18 U.S.C., Chapter 40, Explosives?
(If yes, provide date business began.)
9. Is or will your business and/or operations be: (Check appropriate box)
Individually Owned A Partnership A Corporation Other (Specify)
Residence ( )
Yes/Date: No
Emergency ( )
FOR ATF USE ONLY
Attach 2” x 2” Photograph Here
(See Instruction 8)
ATF Form 5400.13/5400.16
Revised March 2009
OMB No. 1140-0070
Fax ( )
5b. Mailing Address (If different from address in item 5a.)
NOTE: A completed FD-258 (Finger-
print Identification Card) must accom-
pany this application. (See Instruction 8)
E-Mail Address
10. Method of Payment (Check one)
Name as Printed on Your Credit/Debit Card
Credit/Debit Card Number (No dashes)
Credit/Debit Card
Billing Address:
Visa Mastercard
American
Express
Discover
Diners Club
Address:
City:
State: Zip Code:
Please Complete to Ensure Payment is Credited to the Correct Application:
I am Paying the Application Fee for the Following Person, Corporation, or Partnership:
Total Application Fees:
Signature of Cardholder
I Authorize ATF to Charge my Credit/Debit Card the Above Amount.
Date
$
Check (Enclosed)
Your credit/debit card will be charged the above stated amount upon receipt of your application. The charge will be reflected on your credit/debit card
statement. In the event a license/permit is NOT issued, the above amount will be credited to the credit/debit card noted above.
Cashier’s Check or
Money Order (Enclosed)
Expiration Date (Month & year)
Responsible Person(s) List
11. Provide information for each individual owner, partner, and all other responsible persons (See Definition 3) in the trade or business operations identified in section A, block 2. List all names used by
each responsible person (i.e., nicknames, maiden name, name from previous marriage, etc.) (If additional space is needed use a separate sheet.)
Full Name
(If the individual is an alien, also
provide his/her U.S.-issued alien
number or admission number.)
a
Position at
Business
b
Home Address and
E-mail Address
(Include ZIP Code)
d
Date of Birth
(Month/day/
year)
(XX/XX/XXXX)
f
Country/
Countries
of
Citizen-
ship
h
Sex
i
Telephone
Numbers
(Home/Work)
e
Social Security
Number
(Voluntary-
will help prevent
misidentification)
c
Place of Birth
g
ATF Form 5400.13/5400.16
Revised March 2009
Race
j
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other
Pacific Islander
White
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other
Pacific Islander
White
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other
Pacific Islander
White
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other
Pacific Islander
White
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other
Pacific Islander
White
12. Application is made for an explosives license or permit under 18 U.S.C., Chapter 40, as an: (See definitions 5 through 9)
Explosives License
Fee
Manufacturer (Check the types of explosives you plan to
manufacture:)
$200
Importer (Check the types of explosives you plan to import:)
$200
Dealer (Check the types of explosives you plan to deal in:)
$200
Renewal
Fee
$100
$100
$100
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
Explosives Permit
$50
Renewal
Fee
$100
Fee
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
User of Explosives (Check the types of explosives you
plan to use:)
$ 12
$ 75
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
User (Limited) of Explosives (Check the types of
explosives you plan to use:)
Limited Permit (Intrastate Only) (Check the types of
explosives you plan to use:)
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
Dynamite
Detonators
Blasting Agents
Black Powder
Cast Boosters
Fireworks
Other (Specify)
$ 25
13. Is State or local license or permit required for explosives business and/or operations? (If yes, provide license/permit numbers; if applied for
license/permit but not yet obtained, provide date of application.)
Yes/Numbers or Date No
14. Is the applicant or any person named in item 11: (ALL questions must be answered by checking the “YES” or “NO” box.) (Give full
details on a separate sheet for all “yes” answers in item 14.)
a. A fugitive from justice?
b. An unlawful user of, or addicted to, marijuana or any depressant, stimulant, or narcotic drug, or any other controlled substance?
a. Been convicted in any court of a felony, or any other crime, for which the judge could have imprisoned that person for more than
one year, even if he or she received a shorter sentence, including probation? (See Definition 1 and Exception 1.)
c. Under indictment or information in any court for a felony, or any crime, for which the judge could imprison that person for more
than one year? (An information is a formal accusation of a crime by a prosecutor.) (See Definition 1.)
b. Been adjudicated mentally defective (which includes having been adjudicated incompetent to manage his or her own affairs) or
been committed to a mental institution?
c. Been discharged from the Armed Forces under dishonorable conditions?
d. Renounced his or her United States citizenship?
d. An alien in the United States? (If “yes,” attach an explanatory statement showing that the person is a lawful permanent resident
or a lawful nonimmigrant or refugee/asylee.) (See Definition 2 and Exception 2.)
e. Presently appealing a conviction of a crime punishable by imprisonment for a term exceeding one year? (If “yes,” attach an
explanatory statement showing date of conviction, court in which convicted, and court in which appeal is pending.)
Yes No
If the individual is an alien, provide the U.S.-issued alien number or admission number in item 11.
15. Has the applicant or any person named in item 11 EVER: (Give full details on a separate sheet for all “yes” answers in item 15.) Yes No
Statement attached.
Statement attached.
Section B (Must be completed)
16. Hours of Operation of Applicant’s Business and/or Operations:
Time
Open
Close
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
17. Applicant’s Business and/or Operation is Located in:
A Commercial Building A Residence Other (Specify)
19. Does User Permit Applicant Intend to Transport Explosive Materials in
Interstate or Foreign Commerce? (If “yes,” state where)
YesNo
20. Does User Permit Applicant Intend to Purchase Explosive Materials in
Interstate or Foreign Commerce? (If “yes,” state where)
YesNoN/A
N/A
Total Fees $
ATF Form 5400.13/5400.16
Revised March 2009
18. Applicant’s Business and/or Operations Premises are:
Owned Leased/Rented* Other (Specify)
21. Do You Deal in Black Powder? Do You Have a Federal Firearms License? (If “yes,” provide the Federal firearms license number)
Yes Federal Firearms License #:No
Storage Facility Data
Section 842(j), 18 U.S.C., provides “It shall be unlawful for any person to store any explosive material in a manner not in conformity with regulations
promulgated by the Attorney General.” Before applying for a license or permit, the applicant must read and be familiar with the requirements as set forth in
27 CFR, Part 555, Subpart K - STORAGE. An application for a license will be denied if upon an investigation it is found that storage facilities
are inadequate.
22a. Are all of the applicant’s storage facilities are listed on the attached Explosives Storage Magazine Description Worksheet(s) and meet the minimum
requirements as set forth in 27 CFR, Part 555, Subpart K - Storage? If “no” (i.e., storage facilities do not meet minimum requirements) explain on
separate sheet. (See Instruction 10.)
Yes No
Section C - Certification (Must be completed by all applicants)
23. Under the penalties imposed by 18 U.S.C. 844, I certify that the answers are true, correct, and complete. I also certify that I am familiar with all
published State laws and local ordinances relating to explosive materials for the location in which I intend to do business. In addition, if the application
is for a Limited Permit, I certify that I will not receive explosive materials on more than 6 separate occasions during the 12-month period for which my
limited permit is valid.
Applicant’s Signature Title Date
For Bureau of Alcohol, Tobacco, Firearms, and Explosives Use Only
22b. Please indicate the total number of explosives storage magazine(s).
22c. If the applicant has no storage facilities, provide contingency plan for unexpected surplus explosive materials by completing Explosives Storage
Magazine Description Worksheet Item J. (See Instruction 10.)
24. Application is Reason for Disapproval/Termination
Approved Withdrawn*
DateSignature of Licensing Official
ATF Form 5400.13/5400.16
Revised March 2009
Disapproved* *(Fee will be refunded)
Explosives Storage Magazine Description Worksheet
(Submit one for each magazine; you may photocopy for additional magazines)
Applicant name:
Magazine ID. no.:
State/local explosives magazine certificate number, if any:
Storage magazine address:
A. Type of magazine (e.g., permanent, mobile/portable, indoor/outdoor, building, igloo, tunnel, dugout, box, trailer, semitrailer, or other mobile magazine):
ATF Type: (Check one) I II III IV V
B. Location of magazine and distance from licensed place of business and other magazines:
C. Distance to nearest storage magazine, regardless of ownership:
D. Describe terrain features, roads, structures, buildings, utilities, etc., that could be damaged if the contents of the magazine exploded:
E. Distance(s) between the magazine and the feature(s):
Indicate if magazine is: Barricaded Unbarricaded
Show distance in feet to: Closest highway: Closest inhabited bldg.:
Closest passenger railway:
F. Materials, including thicknesses, used in construction of magazine:
Roof: Top: Walls: Bottom:
Doors: Floor:
G.
1. Security, physical safeguards, safety equipment, and anti-theft measures:
2. Locks (Check all that apply): Three-point Lock Mortise Locks Padlocks
3. If Padlocks: Shackle Diameter: No. of Tumblers: Steel Hoods: Yes No Case-hardened: Yes No
H. Dimensions and capacity of magazine:
Capacity: Height: Length: Width:
(In pounds or number of detonators)
I. Explosives to be stored: Quantity or Weight
Class: High Low Blasting Agents Detonators
J.
1. Magazine is (Check one): Owned Borrowed Leased Rented Contingency
Plan
2. Owner of magazine if borrowed, leased, rented, or on contingency:
3. Address and phone number of owner:
K. Names and telephone numbers of persons who can open magazine for inspection:
L. Special conditions, such as difficulty accessing in winter, etc.:
M. A plat plan must be be furnished, not necessarily to scale, which will indicate, at a minimum, (1) all buildings on the premises, and (2) all magazines
identified, with distances between the magazines, as well as the distances between magazines and inhabited buildings, public highways, and passenger
railways.
Prepared by: Date:
(Name and Title)
ATF Form 5400.13/5400.16
Revised March 2009
For ATF Use Only
Global Positioning System (GPS)
Coordinates
All Applications are to be Submitted with Fees to:
Bureau of Alcohol, Tobacco, Firearms, and Explosives
P.O. Box 409567
Atlanta, GA 30384-9567
Instructions
1. Issuance of your license or permit under 18 U.S.C., Chapter 40, will be
delayed if the fee is omitted or incorrect, or if the application is incom-
plete or otherwise improperly prepared. This application should be
submitted at least 90 days prior to the time the license or permit is required.
2. Submit the original of this form (either typewritten or printed legibly)
and total fees payable to the Bureau of Alcohol, Tobacco, Firearms, and
Explosives to the post office box listed above. (CAUTION: Submission
of this application does NOT authorize you to engage in any of the
activities covered by the requested license or permit. The license or
permit must be received before operations commence.) Include your
social security or employer identification number on your check or
money order.
3. If separate sheets are needed to respond to the questions, they must be
identified with your name and address at the top of the page and
reference the question number being explained.
4. A separate or additional license is not required for storage facilities
operated by the applicant as an integral part of one business premises, or
to cover a location used by the applicant solely for maintaining required
records.
5. One PERMIT is required for an individual or business entity to acquire,
use, or transport explosives.
6. A separate application and LICENSE fee are required for each premises
on which explosive materials are, or will be, manufactured, imported, or
distributed.
7. It is not necessary for a licensed manufacturer or licensed importer (for
purposes of sale or distribution) to also obtain a dealer’s license in order
to engage in business on his or her licensed premises as a dealer in
explosives materials. In the case of a licensed manufacturer, a separate
license is not required with respect to onsite manufacturing.
8. A photograph of each responsible person listed in item 11 MUST
accompany this application. The photograph must be 2 x 2 inches in
size, clearly showing a full frontal view of the features of the responsible
person with head bare, with the distance from the top of the head to the
point of the chin approximately 1 1/4 inches, and which shall have been
taken within the last 6 months prior to the date of application.
A completed FD-258 (Fingerprint Identification Card) for each
responsible person, including sole proprietors, MUST also accompany
this application. The fingerprints must be clear for accurate classifica-
tion and must be taken at a local law enforcement agency. In addition,
if you are an alien, you must place your U.S.-issued alien number or
admission number in the miscellaneous block of the FD-258.
9. This application must include the names and identifying information of
EACH employee authorized to possess explosive materials in the course
of his/her employment with the applicant. This information MUST be
submitted on ATF F 5400.28, Employee Possessor Questionnaire, and
included with the submission of this application.
10. For item 21 use the attached Explosives Storage Magazine Description
Worksheet to describe each storage facility (magazine). You may photo-
copy the worksheet if you have more than one magazine. For the
purpose of this worksheet, “barricade” is defined as the effective
screening of a magazine containing explosive materials from another
magazine, a building, a railway, or a highway, either by a natural barri-
cade or by an artificial barricade. To be properly barricaded, a straight
line from the top of any sidewall of the magazine containing explosive
materials to the eave line of any other magazine or building, or to a
point 12 feet above the center of a railway or highway, will pass through
the natural or artificial barricade. A “contingency plan” is required in
the event the explosive materials cannot be used within the same day of
receipt. For example, a sufficient “contingency plan” would include a
letter or statement from someone having approved storage facilities
allowing the applicant use of his facilities should the need arise.
11. The certification in item 22 must be signed (executed) by the owner, a
partner, or in the case of a corporation, association, etc., by an officer
duly authorized to sign for the applicant.
12. If you have any questions relating to this application, please contact
the ATF Federal Explosives Licensing Center, 244 Needy Road,
Martinsburg, WV 25405, (877) 283-3352, or review information online
at www.atf.gov.
13. If the application is approved, the ATF Federal Explosives Licensing
Center (FELC) will forward an explosives license or permit to you. If the
application is denied, you will be advised in writing of the reason(s) for
the denial. If the application is abandoned, denied, or withdrawn, your
application fee will be refunded. However, in order to refund the fee, a
social security number or employer identification number is REQUIRED.
14. Additional forms can be downloaded from ATF’s website in Adobe PDF
format at www.atf.gov/forms/index.htm. The form can be ordered using
ATF’sOnline Distribution Center Order Form at www.atf.gov/dcof/
index.htm, or by calling ATF’s Distribution Center at (301) 583-4696.
Definitions
1. Under Indictment or Information or Convicted in Any Court. An
indictment, information, or conviction in any Federal, State, or local
court.
2. Alien. An alien in the United States means any person who is not a citizen
or national of the United States.
3. Responsible Person. An individual who has the power to direct the
management and policies of the applicant pertaining to explosive
materials. For example, responsible persons generally include sole pro-
prietors and explosives facility site managers. In the case of a corpora-
tion, association, or similar organization, responsible persons generally
include corporate directors and officers, as well as stockholders who have
the power to direct management and policies.
4. Employee Possessor. An employee possessor is an individual who has
actual or constructive possession of explosive materials during the
course of his employment. Actual possession exists when a person is in
immediate possession or control of explosive materials (e.g., an employee
who physically handles explosive materials as part of the production
process; an employee who handles explosive materials in order to ship,
transport, or sell them; or an employee, such as a blaster, who actually
uses explosive materials). Constructive possession exists when an
employee lacks direct physical control over explosive materials, but
knowingly has the power and intention to exercise dominion and control
over the explosive materials, either directly or indirectly through others
(e.g., an employee at a construction site who keeps keys for magazines in
which explosive materials are stored, or who directs the use of explosive
materials by other employees).
5. A User Permit. A User Permit authorizes the holder, on a continuing
basis, to acquire for his own use and not for resale, explosive materials
from an explosives licensee in interstate or foreign commerce, and to
transport explosive materials so acquired in interstate or foreign com-
merce. A User Permit is issued for 3 years and is renewable.
6. Limited Permit. A limited permit authorizes the holder to receive for his
use explosive materials from a licensee or permittee in his State of resi-
dence on no more than 6 occasions during the 12-month period in which
the permit is valid. A limited permit does not authorize the receipt or
transportation of explosive materials in interstate or foreign commerce.
7. Manufacturer. Any person engaged in the business of manufacturing
explosive materials for purposes of sale or distribution or for his own use.
ATF Form 5400.13/5400.16
Revised March 2009
You Must Immediately Contact ATF To Report Lost Or Stolen Explosives!
Call Toll Free: 1-888-ATF-BOMB
ATF Form 5400.13/5400.16
Revised March 2009
8. Importer. Any person engaged in the business of importing or
bringing explosive materials into the United States for purposes of sale
or distribution.
9. Dealer. Any person engaged in the business of distributing explosive
materials at wholesale or retail.
10. High Explosives. Explosive materials which can be caused to detonate
by means of a blasting cap when unconfined (for example, dynamite).
11. Low Explosives. Explosive materials which can be caused to deflagrate
when confined (for example, black powder).
12. Blasting Agents. Any material or mixture, consisting of fuel and
oxidizer, intended for blasting, not otherwise defined as an explosive:
Provided that the finished product, as mixed for use or shipment,
cannot be detonated by means of a numbered eight test blasting cap
when unconfined (for example, ammonium nitrate fuel oil).
Note: There are now six broad categories of explosives licenses and
permits that shall determine the type of business each licensee or permit-
tee is engaged in: Manufacturer of Explosives, Dealer of Explosives,
Importer of Explosives, User of Explosives, User (Limited) of Explosives,
and Limited Permit (Interstate Only).
Exceptions
1. A person who has been convicted of a felony, or any other crime, for
which the judge could have imprisoned the person for more than one
year, is not prohibited from shipping, transporting, possessing, or
receiving explosives if: (1) the conviction was properly invalidated by
a court on the basis that the conviction was unconstitutional; (2) in the
case of a Federal conviction, the person received a Presidential pardon;
or (3) ATF granted relief from Federal explosives disabilities under
18 U.S.C. 845(b), 27 CFR 555.142.
2. For purposes of this form, aliens can be responsible persons if they are
lawful permanent residents or lawful nonimmigrants (or refugees/
asylees). 18 U.S.C. 842(d)(7); (i)(5).
Privacy Act Information
The following information is provided pursuant to Sections 3 and 7(b) of
the Privacy Act of 1974 (5 U.S.C. 552a(e)(3));
1. Authority. Solicitation of this information is made pursuant to 18 U.S.C.
843(a). Disclosure of this information by the applicant is mandatory if
the applicant wishes to obtain a Federal explosives license or permit.
2. Purpose. To identify the applicant; to identify the location of the
premises; to determine the eligibility of the applicant to obtain such
license or permit; to determine the ownership of the business or opera-
tions; and to identify responsible persons in the business or operations.
3. Routine uses. The information will be used by ATF to make a determi
nation as set forth in paragraph 2. In addition, information may be
directly disclosed to other Federal, State, foreign and local law enforce-
ment and regulatory agency personnel to verify information on the
application and to aid in the performance of their duties with respect to
the regulation of explosives unless such disclosure is prohibited by law.
Finally, the information may be disclosed to members of the public in
order to verify the information on the application where such disclosure
is not prohibited by law.
4. Effects of not supplying the requested information. Failure to supply
complete information will delay processing and may cause denial of the
application.
5. Disclosure of social security number. Disclosure of the individual’s
social security number is voluntary. Under 18 U.S.C. 842(f), 843, and
Executive Order 9397, November 22, 1943, ATF has the authority to
solicit an individual’s social security number. The number may be used
to verify the individual’s identity.
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The
information collection is used to determine the eligibility of the applicant to
engage in certain operations, to determine the location and extent of opera-
tions, and to determine whether the operations will be in conformity with
Federal laws and regulations. The information requested is required to obtain
or retain a benefit and is mandatory by statute (18 U.S.C. 843).
The estimated average burden associated with this collection is 1 hour and 9
minutes per respondent or recordkeeper, depending on individual circum-
stances. Comments concerning the accuracy of this burden estimate and
suggestions for reducing this burden should be directed to Reports Manage-
ment Officer, Document Services Section, Bureau of Alcohol, Tobacco,
Firearms, and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid
OMB control number.