I. I, ____________________________, hereby certify under penalty 
         (Full name of officer)
of perjury that I am a law enforcement officer, that the weapon(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)

for use in official duties, that the weapon(s) is/are suitable for

use in performing official duties, and that the weapon(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 #)