Form ATF F 5300.42 ATF F 5300.42 Certification of Secure Gun Storage or Safety Devices

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

OMB No. 1140-0051 (03/31/2009)

Certification of Secure Gun Storage or
Safety Devices

Instructions: 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 (Print or type)
Applicant(s) 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 Form 5300.42
Revised July 2005

Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of the information is to determine that
applicants for a firearms dealers license certify compliance with the requirements for secure gun storage. The information on this
form is required by P.L. 105-277.
The estimated average burden associated with this collection of information is 1 minute per respondent or recordkeeper, depending
on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be addressed to Reports Management 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. Confidentiality is not assured.

ATF Form 5300.42
Revised July 2005