Form ATF Form 5400.13/5 ATF Form 5400.13/5 Application for Explosives License or Permit

OMB No. 1140-0070

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.

FOR ATF USE ONLY

1. Name of Applicant (If partnership, include name of each partner)

3. Employer Identification Number (EIN) or Social
Security Number (SSN) (Voluntary-see Privacy Act
Information)

2. Trade Name or Busniess Name, if any

Attach 2” x 2” Photograph Here

4. Name of County in Which
Business is Located

(See Instruction 8)

5a. Premises Address (No., Street, City, State, Zip Code)

5b. Mailing Address (If different from address in Item 5a.)

NOTE: A completed FD-258 (Fingerprint
Identification Card) must accompany this
application. (See Instruction 8)

6. Location (If no street address listed in Item 5a, provide directions and
distance from nearest post officer or city limits)

7. Telephone Number (Include Area Code)
(

)

Residence (

)

Emergency (

)

Fax

)

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Business

(

E-Mail Address

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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.)
Yes/Date:
No
9. Is or will your business and/or operations be: (Check appropriate box)
Sole Proprietor

Partnership

Corporation

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10. Method of Payment (Check one)
Cashier’s Check or
Check (Enclosed)
Money Order (Enclosed)
Credit/Debit Card Number (No dashes)

Limited Liability Company

Other (Specify)

American
Express
Name as Printed on the Credit/Debit Card

Visa

Diners Club

Discover

Mastercard

Expiration Date (Month & year)

Address:

Credit/Debit Card
Billing Address: City:

State:

Please Complete to Ensure Payment is Credited to the Correct Application:
I am Paying the Application Fee for the Following Person, Corporation, or Partnership :

Zip Code:

Total Application Fees:

I Authorize ATF to Charge my Credit/Debit Card the Above Amount.

Signature of Cardholder

Date

Your credit/debit card will be charged the above stated amount upon receipt of the application. The charge will be reflected on your credit/debit card
statement. In the event your application is NOT approved, the above amount will be credited to the credit/debit card noted above.
ATF Form 5400.13/5400.16
Revised (
)

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.)
Social Security

Full Name
(If the individual is an alien, also

Position at

provide his/her U.S. -issued alien

Business

(Voluntary-

number or admission number.)

b

will help prevent
misidentification)
c

Home Address and
E-mail Address
(Include ZIP Code)
d

Telephone
Numbers
(Home/Work)
e

Date of Birth
Coutry/
Race
(Month/Day/
Countries Sex Ethnicity
Place of Birth
(Mark all that apply)
Year)
of Citi- i
j
g
j
(XX/XX/XXXX)
zenship
f
h
Are you
Hispanic
or
Latino?

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Yes

D

a

Number

No

Are you
Hispanic
or
Latino?
Yes
No

Are you
Hispanic
or
Latino?
Yes
No

Are you
Hispanic
or
Latino?
Yes
No

Are you
Hispanic
or
Latino?
Yes
No

American Indian or
Alaska Native
Asian
Black or Aftrican

American

Native Hawaiian or
Other Pacific slanders
White
American Indian or
Alaska Native
Asian
Black or Aftrican

American

Native Hawaiian or
Other Pacific slanders

White
American Indian or
Alaska Native
Asian
Black or Aftrican

American

Native Hawaiian or
Other Pacific slanders
White

American Indian or
Alaska Native
Asian
Black or Aftrican

American

Native Hawaiian or
Other Pacific slanders
White
American Indian or
Alaska Native
Asian
Black or Aftrican

American

Native Hawaiian or
Other Pacific slanders
White

ATF E-Form 5400.13/5400.16
Revised (
)

12. Application is made for an explosives license or permit under 18 U.S.C., Chapter 40, as an: (See definitions 5 through 9)
Fee Renewal
Fee

Explosives License

User of Explosives (Check the types of explosives you plan
to use:)

Manufacturer (Check the types of explosives you plan to
manufacture:)
High Explosives

Low Explosives
$200

Theatrical Flash Powder

Fireworks

Blasting Agents

Other (Specify)

$100

Fireworks

Blasting Agents

Other (Specify)

$100

$50

$25

$12

Limited Permit (Intrastate Only) (Check the types of
explosives you plan to use:)

Fireworks

Blasting Agents

High Explosives
Low Explosives

Importer (Check the types of explosives you plan to import:)
High Explosives

Fee Renewal
Fee

Explosives License

$200

Other (Specify)

$100

High Explosives

Fireworks

Blasting Agents

Other (Specify)

Low Explosives

Low Explosives
Dealer (Check the types of explosives you plan to deal in:)
High Explosives

Low Explosives

Blasting Agents

Fireworks

Black Powder

Other (Specify)

$100

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$200

Total Fees

$

13. Is a State or local license or permit required for explosive business and/or operations? (If yes, provide license/permit numbers; if applied for
license/permit but not yet obtained, provide date of application.)
No
Yes/Numbers or Date
Yes 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” answer in item 14.)
a. A fugitive from justice?

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b. An unlawful user of, or addicted to, marijuana or any depressant, stimulant, or narcotic drug, or any other controlled substance?
c. Under indictment or information in any court for a felony, or any cime, 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.)

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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.)
Statement Attached.
If the individual is an alien, provide the U.S.-issued alien number or admission number in item 11.
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.)
Statement Attached.
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

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.)
b. Been adjudicated metally defective (which includes having been adjudicated incompetent to manage his or her own affairs) or been
committed to a mental institution?
c. Been discaharged from the Armed Forces under dishonorable conditions?
d. Renounced his or her United States citizenship?
Section B (Must be completed)
16. Hours of Operation and/or Availability of Business Activity (Please provide at least one hour in which you may be contacted by ATF Personnel.)
Time

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Open
Close
17. Applicant’s Business and/or Operation is Located in:
A Commercial Building

A Residence

Other (Specify)
ATF Form 5400.13/5400.16
Revised (
)

18. Applicant’s Business and/or Operations Premises are:
A Leased/Rented*

Owned

19. Does User Permit Applicant Intend to Transport Explosive Materials in
Interstate or Foreign Commerce? (If “yes,” state where)
N/A

No

Other (Specify)
20. Does User Permit Applicant Intend to Purchase Explosive Materials in
Interstate or Foreign Commerce? (If “yes,” state where)
N/A

Yes

No

Yes

21. Do you Intend to Deal in Black Powder? Do You Have a Federal Firearms License? ( If “yes,” provide the Federal Firearms license number)
No

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. All of the applicant’s storage facilities 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.)
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.)

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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 explosives 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
Approved
Disapproved*

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Reason for Disapproval/Termination

24. Application is

Withdrawn*
*(Fee will be refunded)

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Signature of Licensing Official

Date

ATF Form 5400.13/5400.16
Revised ( )

For ATF Use Only

Explosives Storage Magazine Description Worksheet
(Submit one for each magazine; you may photocopy for additional magazines)

Global Positioning System (GPS)
Coordinates

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

V

IV

B. Location of magazine and distance from licensed place of business and other magazine:

C. Distance to nearest storage magazine, regardless of ownership:

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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:
Show distance in feet to:

Barricaded

Unbarricaded

Closet highway:

Closet inhabited bldg:

Closet passenger railway:

F. Materials, including thicknesses, used in construction of magazine:
Top:

Doors:

Floor:

Walls:

Bottom:

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G.

Roof:

1. Security, physical safeguards, safety equipment, and anti-theft measures:

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2. Locks (Check all that apply): Three-point Lock

Mortise Locks

No. of Tumblers:

3. If Padlocks: Shackle Diameter:
H. Dimensions and capacity of magazine:

Capacity (in pounds or number of detonators):

Padlocks

Steel Hoods: Yes
Height

No

Case-hardened: Yes

Length:

No

Width:

I. Explosives to be stored: Quantity or Weight
Class:
J.

High

Low

Owned
Borrowed
1. Magazine is (Check one):
2. Owner of magazine if borrowed, leased, rented, or on contingency:

Blasting Agents
Leased

Detonators
Rented

Contingency Plan

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 furnished, not necessarily to scale, which will indicte, 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 ( )

All Applications are to be Submitted with Fees to:
Bureau of Alcohol, Tobacco, Firearms, and Explosives
Federal Explosives Licensing Center
PO Box 6200-18
Portland, OR 97228-6200
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
incomplete 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.

11. The cerification in item 23 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.

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4. A separate or additional license is not required for storage facilities
operated by the applicant as an integral part of ones business premises,
or to cover a location used by the applicant solely for maintaining
required records.

10. For item 22 use the attached Explosives Storage Magazine
Description Worksheet to describe each storage facility (magazine).
You may photocopy 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 barricade 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.

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 explosives materials are, or will be, manufactured, imported,
or distributed.

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7. It is not necessary for a licensed manufactured or licensed importer (for
purposes of sale or distribution) to also obtaine 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 whith respect to onsite
manufacturing.
8. A photograph of each responsible person listed in item 11 MUST
accompany this application. The photograph must be 2X2 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
responsbile person, including sole proprietors, MUST also accompany
this application. The fingerprints must be clear for accurate
classification 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 submission of this application.

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 (FLEC) 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 numbe is REQUIRED.

14. Additional forms can be downloaded from ATF’s website in Adobe PDF
format at www.atf.gov/forms/download/atf-f5400-13.pdf. The form can
be ordered using ATF’s Online Distribution Center Order Form at
www.atf.gov/dcof or by calling ATF’s Distribution Center at
(202) 648-6420.
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 pertinent to explosive materials.
For example, responsible persons generally include sole proprietors
and explosives facilitiy site managers. In the case of a corporation,
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).

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 (
)

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ATF Form 5400.13/5400.16
Revised (
)