MUST be retyped on letterhead!
For restricted weapons (i.e. Post Ban Assault Rifle and Semi Auto Pistols with Post Ban high capacity magazines) 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, ____________________________, hereby certify under penalty 
         (Full name of officer)
of perjury that I am a law enforcement officer, that the weapon(s)

and/or device(s) being purchased is/are for use in performing my

official duties and that the weapon(s) or device(s) is/are not

being acquired for personal use or for purposes of transfer or

resale.

   _____________________   _________   ________    _______
   (Manufacturer's name)   (Model #)   (Caliber)   (Finish)

   ______________________   ______   _____   _______ _________ 
   (Signature of Officer)   (Date)   (DOB)   (DL#)   (Dept ID#)   


II. I, ____________________________, hereby certify under penalty 
         (Full name of supervisor)
of perjury that I am the supervisor of the above listed purchasing

officer, that the purchasing officer is acquiring the weapon(s)

and/or device(s) for use in official duties, that the weapon(s) 

and/or device(s) is/are suitable for use in performing official

duties, and that the weapon(s) and/or device(s) is/are not being

acquired for personal use or for purposes of transfer or resale.

I also certify that a records check of the purchasing officer has

been conducted and reveals no criminal convictions for misdemeanor

crimes of domestic violence.


___________________________    ___________________________ 
(Signature of Supervisor)      (Dept. Name) 

___________________________    ___________________________
(Name of Supervisor)           (Date)

___________________________    ___________________________
(Department Address)           (Supervisor's Office Phone #)