Form ATF F 5400.6 ATF F 5400.6 User Limited Permit (Explosives)

OMB No. 1140-0027 (10/31/2007)

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

User - Limited Permit
(18 U.S.C. Chapter 40, Explosives)

In accordance with the provisions of Title XI, Organized Crime Control Act of 1979, the regulations issued thereunder (27 CFR Part 555), and the conditions set forth on the back of this permit, you are
authorized to acquire for use the described explosive materials in interstate or foreign commerce and to transport such explosive materials in interstate or foreign commerce. See “WARNING” on back.

Y
L
N
O
E
S
U
E
M
I
T
E
N
O

Direct ATF
Correspondence
To

Name

Type of Permit

Chief, Federal Explosives Licensing Center
244 Needy Road
Martinsburg, WV 25405

Permit
Number
Issue
Date

Premises Address

Quantity (Fireworks Display N/A)

Chief, Federal Explosives Licensing Center

Transaction Date

Distributor’s Use Only
Distributor’s License No.

Permittee Mailing Address

Signature of Distributor

ATF Form 5400.6
Revised November 2004

OMB No. 1140-0027 (10/31/2007)

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

Record Copy - User - Limited Permit
(18 U.S.C. Chapter 40, Explosives)

Y
L
N
O
E
S
U
E
M
I
T
E
N
O

In accordance with the provisions of Title XI, Organized Crime Control Act of 1979, the regulations issued thereunder (27 CFR Part 555), and the conditions set forth on the back of this permit, you are
authorized to acquire for use the described explosive materials in interstate or foreign commerce and to transport such explosive materials in interstate or foreign commerce. See “WARNING” on back.

Direct ATF
Correspondence
To

Name

Type of Permit

Chief, Federal Explosives Licensing Center
244 Needy Road
Martinsburg, WV 25405

Permit
Number
Issue
Date

Premises Address

Quantity (Fireworks Display N/A)

Chief, Federal Explosives Licensing Center

Transaction Date

Distributor’s Use Only
Distributor’s License No.

Permittee Mailing Address

Signature of Distributor

ATF Form 5400.6
Revised November 2004

Warning
This permit does not confer the right or privilege to conduct business contrary to State law or any other law. Whenever a person who possesses a permit under 18 U.S.C. Chapter 40 becomes a
fugitive from justice; is an unlawful user of or addicted to marijuana, or any depressant or stimulant drug or narcotic drug, or (as these terms are defined in the Controlled Substances Act, 21 U.S.C. 802)
is adjudicated as a mental defective or is committed to a mental institution; is indicted, under information, or is convicted in any court of a crime punishable by imprisonment for a term exceeding one
year, such person is prohibited from shipping or transporting any explosives in interstate or foreign commerce or from receiving any explosives which have been shipped or transported in interstate or
foreign commerce.
Conditions
1.

This permit is not transferable and valid only for a single transaction involving the type and quantity of explosive materials specified on the permit.

2.

The permittee shall present this permit at the time of acquiring, from a licensee, the explosive materials authorized by this permit.

3.

The distributor (seller) shall, at the time distribution is made to the permittee, write on the face of this permit the transaction date, sign his/her name and indicate his/her license number, and
return this permit to the permittee.
Notice To Buyer

Explosive materials must be stored in compliance with requirements set forth in 27 CFR Part 555. It shall be unlawful for any person to store any explosive materials in a manner not in conformity with
these regulations. A buyer storing explosive materials should become familiar with storage requirements before storing explosive materials.
Please include your permit number on all correspondence with the Bureau.
Report all thefts of explosives to ATF (1-800-800-3855) and appropriate local authorities within twenty-four (24) hours.
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction of 1995. The purpose of this information is to allow the permittee to have evidence that he/she lawfully acquired the explosives. It also
shows that the seller lawfully disposed of explosives to a permittee. This form is subject to ATF inspection. The information is mandatory (18 U.S.C. 843)f)).
The estimated average burden associated with this collection is 12 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be directed to Reports Management Officer, Document Services Branch, 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.

ATF Form 5400.6
Revised November 2004

MARGINALS FOR ATF Form 5400.6:
Copy 1 - Distributor’s Copy
Copy 2 - ATF Division Copy
Copy 3 - Purchaser’s Copy