1.
NAME:
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Enter first , middle initial
and last name.
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2.
TRADE NAME:
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Leave blank.
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3.
EMPLOYER IDENTIFICATION NO. OR SOCIAL SECURITY NO.:
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Enter social security number
in a xxx-xx-xxxx format.
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4.
NAME OF COUNTY:
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Enter name of county or
parish. Note: Do not enter USA or United States of America.
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5.
ADDRESS:
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Enter your mailing address.
Note: This address may be a P.O.
Box or a RFD Box number.
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6.
LOCATION:
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Enter your physical address.
Note: This address may NOT contain
a P.O. Box or a RFD Box number.
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7.
TELEPHONE NUMBER:
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Enter the phone number for
either your business, residence or both. These are the phone numbers the ATF field
agent will use to contact you in order to schedule a personal interview.
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8.
ARE YOU PRESENTLY ENGAGED IN A BUSINESS FOR WHICH A LICENSE OR PERMIT IS
REQUIRED UNDER 18 U.S.C., CHAPTER 40, EXPLOSIVES:
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Check the NO box.
Note: If you are applying for a personal
permit only, you are not engaged in a business.
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9.
IS OR WILL YOUR BUSINESS BE:
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Even though you may not
be a commercial entity, check the INDIVIDUALLY OWNED box.
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10.
APPLICATION IS MADE FOR A LICENSE OR PERMIT UNDER 18 U.S.C., CHAPTER 40
AS A:
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Under the column TYPE CODE,
circle the number 34.
Under the X column, place an X to the right of User of Low Explosives.
At the bottom of the table, be sure to check either the CHECK or MONEY ORDER box as applicable.
Enter $200.00 in the box labeled TOTAL AMOUNT. Note: Do not send cash.
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11.
LIST THE TYPES OF EXPLOSIVES MATERIALS YOU INTEND TO MANUFACTURE,
IMPORT, DEAL OR USE:
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List the following items.
a. Rocket Motors
b. Igniters
c. Black Powder
d. Ammonium Perchlorate Composite Propellant
e. Igniter Cord
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12.
IS STATE OR LOCAL LICENSE OR PERMIT REQUIRED FOR EXPLOSIVE OPERATIONS?:
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Check either the YES or
NO box. The answer will depend on state/local statues and regulations.
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13.
DATE OPERATIONS REQUIRING A LICENSE OR PERMIT ARE DESIRED TO COMMENCE:
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List a date. It is highly
recommended to list a date that is a minimum of 45 days more than the date the application
is mailed. Listing a date less than 45 days will not expedite the application process.
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14.
ALL OF THE STORAGE FACILITIES LISTED ON ATTACHED SHEETS, IF, ANY,
MEET THE MINIMUM REQUIREMENTS AS SET FORTH IN 27 CFR PART 55,
SUBPART K - STORAGE:
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Check the box yes
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15.
TYPE, LOCATION AND DESCRIPTION OF EACH PERMANENT STORAGE FACILITY:
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Complete attached explosive storage
magazine description worksheet(s) (See 1,11 & 16 on the instructions
on the front of the form)
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16. Furnish
a plat plan of the premises using the attached explosives storage
magazine description worksheet.:
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Plat = a plotted map, chart or plan.
Attach separate sheets(s) (See 1,11 & 16 on the instructions on the front of the form)
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17.
LIST BELOW THE INFORMATION FOR EACH INDIVIDUAL OWNER, PARTNER AND OTHER
RESPONSIBLE PERSONS IN THE APPLICANT BUSINESS. LIST ALL NAMES USED BY EACH
RESPONSIBLE PERSON:
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List your full name in column
a.
Write INDIVIDUAL and your social security number in column b.
List your home address in column c.
List your place of birth in column d in a city, state format.
List your date of birth in column e in a mm/dd/yy format.
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18
a-d. APPLICANT OR ANY PERSON NAMED IN ITEM 18 ABOVE:
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Check the YES or NO boxes
as applicable.
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19
a-b. HAS APPLICANT OR ANY PERSON NAMED IN ITEM 18 EVER:
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Check the YES or NO boxes
as applicable.
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20.
HOURS OF OPERATION OF APPLICANT'S BUSINESS:
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Even though you may not
be a commercial entity, you must list some hours. It is common for applicants to
list four hours on one day.
Note: The hours listed will be the
hours ATF will most likely arrange to contact you if a need should
arise in the future.
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21.
LICENSE APPLICANT'S BUSINESS IS LOCATED IN:
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Check the A RESIDENCE box.
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22.
PERMIT APPLICANT INTENDS TO TRANSPORT EXPLOSIVE MATERIALS IN INTERSTATE
OR FOREIGN COMMERCE?:
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Check the NO box.
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23.
PERMIT APPLICANT INTENDS TO PURCHASE EXPLOSIVE MATERIALS IN INTERSTATE
OR FOREIGN COMMERCE?:
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Check the YES box and write
on the line to the right CONUS or Continental United States.
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24.
TYPE 29 LICENSE APPLICANT: DO YOU HAVE A FEDERAL FIREARMS LICENSE?:9
LICENSE APPLICANT: DO YOU HAVE A FEDERAL FIREARMS LICENSE?:
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Check the NO box. Unless
you have one then write in the Federal Firearms License number)
Note: If you
are applying for a User of Low Explosive Permit, you are not applying for
a Type 29 license.
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25.
SECTION C - CERTIFICATION:
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Be sure to sign
the application. In the TITLE column list INDIVIDUAL. List the date for the
DATE column.
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