Storage Statement WESTERN AUSTRALIA Firearms Act 1973 Storage Statement (Statutory Declaration).

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1 Storage Statement WESTERN AUSTRALIA Firearms Act 1973 Storage Statement (Statutory Declaration). Information Line FORM 22 Family Name Given name Date of birth / / Firearms Licence Number Number/Street Suburb State Post Code WA Day Time Contact Number Address Please tick box if you approve to receiving electronic correspondence. STORAGE I, the person described above, sincerely declare as follow: To ensure that any firearm or ammunition in my possession is stored in accordance with the Firearms Regulations 1974 r. 11A, I have: A lockable cabinet or container that at least meets the specifications described in schedule 4 of those regulations. A separate lockable ammunition container or cabinet that at least meets the specifications described in schedule 4 regulation 11A (2) & (8) (Not required for collectors licences) Please describe This section is mandatory. Is cabinet a commercial produced model or custom made? If commercially produced make and model (if known) Storage capacity (number of firearms capable of holding) Is cabinet securely anchored from the inside at 2 points on each of 2 separate surfaces to 2 immovable structural surfaces What material are the 2 separate surfaces (eg concrete, timber, bricks) Are the masonary bolts or coach screws used at least 8mm x 75mm? Yes / No Yes / No

2 Are the washers used to reinforce between surface of cabinet and fixing bolt/screw at least 40mm x 40 mm x 2 mm plate or washer? Yes / No Any additional security arrangements (eg CCTV, alarm system) OR Please describe Other storage facilities as follows:- (Describe your alternate storage. This storage will require approval from Licensing Services before it will be accepted as alternate storage) STORAGE LOCATION Same as residential Yes / No If different Number/Street Suburb State Post Code WA DECLARATION Proof of purchase/fitting of an approved lockable cabinet or other storage facility attached. Photograph of approved lockable cabinet or other storage facility attached Photographs are mandatory This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular. This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005 at on 20 by: in the presence of this authorised witness: Name Qualification as authorised witness

3 Annexure You will need to attach good quality photographs of your storage cabinet before signing the Statutory Declaration. Name Qualification as authorised witness Date

4 EXAMPLE OF A CORRECTLY COMPLETED FORM 22 STORAGE STATEMENT AND FIXING WITHIN A SHED STRUCTURE INFORMATON

5 Storage Statement WESTERN AUSTRALIA Firearms Act 1973 Storage Statement (Statutory Declaration). Information Line FORM 22 Family Name SMITH Given name John Steven Date of birth 11 / 06 / Number/Street 459/63 Gator Street Firearms Licence Number Suburb State Post Code Walliston WA 6076 Day Time Contact Number Address (08) Please tick box if you approve to receiving electronic correspondence. STORAGE I, the person described above, sincerely declare as follow: Ammunition is not to be stored in a cabinet or container in which a firearm is stored unless the ammunition is in another locked metal container in which no firearm is stored & which is securely affixed so as to prevent its removal from the cabinet or container. To ensure that any firearm or ammunition in my possession is stored in accordance with the Firearms Regulations 1974 r. 11A, I have: A lockable cabinet or container that at least meets the specifications described in schedule 4 of those regulations. A separate lockable ammunition container or cabinet that at least meets the specifications described in schedule 4 regulation 11A (2) & (8) (Not required for collectors licences) Please describe This section is mandatory. Is cabinet a commercial produced model or custom made? If commercially produced make and model (if known) Custom N/A Storage capacity (number of firearms capable of holding) 10 Is cabinet securely anchored from the inside at 2 points on each of 2 separate surfaces to 2 immovable structural surfaces Yes / No What material are the 2 separate surfaces (eg concrete, timber, bricks) Are the masonary bolts or coach screws used at least 8mm x 75mm? Are the washers used to reinforce between surface of cabinet and fixing bolt/screw at least 40mm x 40 mm x 2 mm plate or washer? Brick Wall, Concrete Floor Yes / No Yes / No

6 Any additional security arrangements (eg CCTV, alarm system) Monitored Alarm OR Please describe Other storage facilities as follows:- (Describe your alternate storage. This storage will require approval from Licensing Services before it will be accepted as alternate storage) STORAGE LOCATION Same as residential Yes / No All storage cabinets that are installed in shipping containers, caravans etc. are classed as Alternative Storage. You need to supply details of all aspects of Alternative Storage If different Number/Street 72 Walter Road Storage location only needs to be completed if the storage address is different from your residential address Suburb State Post Code Morley WA 6061 DECLARATION Proof of purchase/fitting of an approved lockable cabinet or other storage facility attached. Photograph of approved lockable cabinet or other storage facility attached Photographs are mandatory This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular. This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005 at Mandurah on 15 January 2015 by: John S. Smith Signed in front of an authorised witness in the presence of this authorised witness: Clare Voyant Clare Voyant Name Justice of the Peace Qualification as authorised witness Witnessed by an authorised person

7 Annexure You will need to attach good quality photographs of your storage cabinet before signing the Statutory Declaration. Clare Voyant Clare Voyant J.P Name Justice of the Peace Qualification as authorised witness 15/01/2015 Date

8 Fixing within a shed structure When a storage cabinet is to be installed in a shed facility you are still required to conform to the Firearms Regulations 1974, Schedule 4, Section 5 (Anchoring) Section 5. Anchoring (1) The cabinet or container is to be securely anchored from the inside at 2 Points on each of 2 separate surfaces to 2 immovable structural surfaces by means of 8 mm x 75 mm masonry fixing bolts or coach screws, as is appropriate. (2) At each anchor point the cabinet or container is to be reinforced with a 40mm x 40 mm x 2 mm metal plate, or a 40 mm x 2 mm metal washer, fitted between the surface of the cabinet or container and the head of the bolt or coach screw. Cabinets must be placed onto a solid concrete surface or immovable solid floor surface where it can be secured to the floor as described above. The 2 side anchoring points must be to a solid support beam of the shed. When installing bolts to the support any exposed bolt heads should be either altered to prevent a spanner being fitted (rounding off with a grinder), or welded securely to the support beam to prevent loosening or tampering with the bolt. All nuts should be installed from within the cabinet and not outside. Additionally, a cabinet owner may wish to stitch weld sections of the cabinet to the upright support for security, however this is not a requirement.

9 STATUTORY DECLARATION Authorised witnesses for statutory declarations Item Formal description Informal description 1. A member of the academic staff of an institution established under any of the following Acts Curtin University of Technology Act 1966; Edith Cowan University Act 1984; Murdoch University Act 1973; University of Notre Dame Australia Act 1989; University of Western Australia Act 1911; Vocational Education and Training Act A member of any of the following bodies Association of Taxation and Management Accountants (ACN ); CPA Australia (ACN ); The Institute of Chartered Accountants in Australia (ARBN ); National Institute of Accountants (ACN ); National Tax & Accountants' Association Limited (ACN ). Academic (post-secondary institution) Accountant 3. A person who is registered under the Architects Act Architect 4. An Australian Consular Officer within the meaning of the Consular Fees Act 1955 of the Commonwealth. 5. An Australian Diplomatic Officer within the meaning of the Consular Fees Act 1955 of the Commonwealth. 6. A bailiff appointed under the Civil Judgments Enforcement Act Bailiff 7. A person appointed to be in charge of the head office or any branch office of an authorised deposit-taking institution carrying on business in the State under the Banking Act 1959 of the Commonwealth. 8. A member of Chartered Secretaries Australia Limited (ACN ). 9. A pharmaceutical chemist within the meaning of the Pharmacy Act Australian Consular Officer Australian Diplomatic Officer Bank manager Chartered secretary Chemist 10. A chiropractor within the meaning of the Chiropractors Act Chiropractor 11. A person registered as an auditor or a liquidator under the Corporations Act 2001 of the Commonwealth. 12. A judge, master, magistrate, registrar or clerk, or the chief executive officer, of any court of the State or the Commonwealth. 13. A member of the Australian Defence Force who is an officer within the meaning of the Defence Force Discipline Act 1982 of the Commonwealth; a non-commissioned officer within the meaning of that Act with 5 or more years of continuous service; or a warrant officer within the meaning of that Act. Company auditor or liquidator Court officer 14. A dentist within the meaning of the Dental Act Dentist 15. A medical practitioner within the meaning of the Medical Act Doctor 16. A member of the Institution of Engineers, Australia, other than at the grade of student. 17. The secretary of an organisation of employees or employers that is registered under one of the following Acts Industrial Relations Act 1979; Workplace Relations Act 1996 of the Commonwealth. Defence force officer Engineer Industrial organisation secretary

10 18. A member of the National Insurance Brokers Association of Australia (ACN ). Insurance broker 19. A Justice of the Peace. Justice of the Peace 20. A legal practitioner within the meaning of the Legal Practice Act The chief executive officer or deputy chief executive officer of a local government. 22. A member of the council of a local government within the meaning of the Local Government Act A member of the Australasian Institute of Chartered Loss Adjusters (ACN ). 24. An authorised celebrant within the meaning of the Marriage Act 1961 of the Commonwealth. 25. A member of either House of Parliament of the State or of the Commonwealth. 26. A minister of religion registered under Part IV Division 1 of the Marriage Act 1961 of the Commonwealth. Lawyer 27. A nurse within the meaning of the Nurses Act Nurse 28. A registered optometrist within the meaning of the Optometrists Act A registered patent attorney under the Patents Act 1990 of the Commonwealth. 30. A physiotherapist within the meaning of the Physiotherapists Act A podiatrist within the meaning of the Podiatrists Registration Act Local government CEO or deputy CEO Local government councillor Loss adjuster Marriage celebrant Member of Parliament Minister of religion Optometrist Patent attorney Physiotherapist Podiatrist 32. A police officer. Police officer 33. The person in charge of an office established by, or conducted by an agent of, Australia Post within the meaning of the Australian Postal Corporation Act 1989 of the Commonwealth. 34. A registered psychologist within the meaning of the Psychologists Registration Act Post office manager Psychologist 35. A public notary within the meaning of the Public Notaries Act Public notary 36. An officer of the Commonwealth public service. Public servant (Commonwealth) 37. A person who is employed under the Public Sector Management Act 1994 Part The holder of a licence under the Real Estate and Business Agents Act Public servant (State) Real estate agent 39. The holder of a licence under the Settlement Agents Act Settlement agent 40. The Sheriff of Western Australia and any deputy sheriff appointed by the Sheriff of Western Australia. 41. A licensed surveyor within the meaning of the Licensed Surveyors Act A person employed as a member of the teaching staff within the meaning of the School Education Act 1999 or as a teacher of a nongovernment school within the meaning of that Act. 43. A member, registrar or clerk, or the chief executive officer, of any tribunal of the State or the Commonwealth. 44. A registered veterinary surgeon within the meaning of the Veterinary Surgeons Act Sheriff or deputy sheriff Surveyor Teacher Tribunal officer Veterinary surgeon