Firearm Safety Device

Firearm Safety Device Tax Credit

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Form FSD

Virginia Form FSD

(Tax Credit Unit)

Application for Firearm Safety Device Tax Credit

One Application Submission Per Year

Taxable Year

Taxpayer Information

Your Social Security Number (SSN)

First Name

Last Name

Address

City

State

ZIP

Eligible Firearm Safety Device Purchase Information and Credit Computation

Complete all columns in the table below. Identify the type of eligible firearm safety device using one of the 5 categories below (enter the corresponding code). Safety Device Category Codes: (A) Safe, (B) Gun Safe, (C) Gun Case, (D) Lock Box, (E) Other storage device- that 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. Taxpayers are eligible for a Firearms Safety Device Tax Credit who purchase one or more firearm safety devices from a federally licensed dealer pursuant to 18 U.S.C. § 923. To find the list of federally licensed dealer, click on the link: Federal Firearms Listings | Bureau of Alcohol, Tobacco, Firearms and Explosives (atf.gov)

Safety Device Category

Device Manufacturer/Brand Name

Model Number

Name of Federally Licensed Dealer

Purchase Date (mm/dd/yyyy)

Eligible Purchase Expenses

Remove Add

Total Eligible Purchase Expenses. ( device(s) )

Requested Credit: The amount is from total expenses or $300 (whichever is less).

Sign & Confirm

Electronic Signature (required)

I the undersigned declare, under the penalties provided by law, that this form (including any accompanying schedules, statements, and attachments) has been examined by me and is, to the best of my knowledge and belief, a true, correct, and complete application, made in good faith pursuant to the income tax laws of the Commonwealth of Virginia.

Printed Name

Phone Number

Tax Preparer Authorization (optional)

By checking the box to the left, I (we) authorize the Virginia Department of Taxation to discuss this return with the undersigned Tax Preparer.

Are you the Tax Preparer?

Yes No

Phone Number

Preparer FEIN/TIN

Preparer Name

Email Confirmation (optional)

If you wish to receive a copy of the confirmation PDF, enter your email address below. This is optional and is provided as a backup if you cannot open/save the PDF on the next page. Entering your email address permits the Virginia Department of Taxation to email you the confirmation PDF for this transaction, which contains return and payment details.

The Department of Taxation discourages using non-business email addresses or shared mailboxes. Do not share this email or the contents therein with unauthorized persons. The Department of Taxation does not assume responsibility if an incorrect email address is entered.

Email Address

Re-Enter Email Address

Firearm Safety Device Tax Credit

Form FSD

Virginia Form FSD

Application for Firearm Safety Device Tax Credit

Taxable Year

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