MUST be retyped on letterhead!
For shipping weapons to an individual officer in care of the department. THE FOLLOWING MUST BE TYPED EXACTLY, OR PRINTED FROM THE LINK BELOW, ON ORIGINAL DEPARTMENT LETTERHEAD AND HAND SIGNED BY THE AUTHORIZED OFFICER AND SUPERVISOR AUTHORIZED TO SIGN SAID LETTERS.
  • NO FAXES WILL BE ACCEPTED!
  • NO COPIED LETTERHEADS WILL BE ACCEPTED!
  • All weapons must be shipped to the department--"Attn: the certifying supervisor"


  • Click here for a version to print on your department letterhead!



    I. I, ______________________#______, an Officer with _________________,
          (Full name of officer) (Dept ID#)              (Dept. Name)
    am authorized to purchase the following weapon to be used in the
    performance of my official duties.  I certify under penalty of perjury 
    that the firearm is not being purchased for personal use or for the 
    purposes of transfer or resale.
    
    Exact Firearm Description 
     _____________________   _________   ________  _____________________   
     (Firearm Make)          (Model #)   (Caliber) (officer contact ph#)
    
    II. I, ____________________________, herby certify that the above named 
            (Full name of supervisor)
    law enforcement officer is currently employed with the _______________,
                                                           (Dept. Name)
    and the firearm being purchased will be used by the officer in the
    performance of official duties. 
        I further certify that a records check has been conducted on the 
    law enforcement officer who is purchasing the firearm and reveals no 
    convictions for misdemeanor crimes of domestic violence.
     
    ___________________________    ___________________________ 
    (Signature of Supervisor)      (Name of officer requesting purchase)
    ___________________________    ___________________________
    (Name of Supervisor)           (Date)
    ___________________________    ___________________________
    (Department Address)           (Supervisor's Office Phone #)