Law Enforcement Sales, USA - Individual Officer Purchase Form

[ Official Department Letterhead ]

Arnold Freeman

Law Enforcement Sales, USA

703 S. 1st Street, Suite 4

Lamesa, Texas 79331-6249

Date: January 1^st, 2004

RE: Officer/Agent/Deputy/SFC John Doe

I hereby certify that the above named individual will use the requested firearm and/or

high capacity ammunition feeding device in the performance of official duties and/or

training duties. In addition, this individual does not have any convictions for crimes

of violence; has not been convicted of any crime for which the penalty could have

been longer than one year, regardless of the actual sentence imposed; that he/she is

not subject to any restraining order restraining him/her from harassing, stalking or

threatening an intimate partner or child of such partner; and he/she has not been

convicted in any court of a misdemeanor crime of domestic violence.

Furthermore; I hereby certify, under penalty of perjury, that the above named individual

will use the requested large capacity ammunition feeding devices for use in performing

official duties and/or training duties and that the large capacity ammunition feeding

devices are not being acquired for personal use or for purposes of transfer or resale.

¾¾¾¾¾¾¾¾¾¾¾¾¾¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾

Officer/Agent/Deputy John Doe Chief, Sheriff, Captain, etc

123 Main Street

Anytown, USA 00000

This is the only letter that is acceptable to the BATFE and the wording in the above paragraphs

must be exact in content. This letter replaces the BATFE form 4473 for the dealer and is

subject to inspection from the BATFE. There is no reason to include the weapon model or serial

number in the body of the letter , that information is noted on the letter at the time of the sale

and transfer. The letter MUST be on Official Agency Letterhead and signed by both the

purchasing officer and supervisor.