Law enforcement

SAMPLE LETTER - INDIVIDUAL OFFICER PURCHASE

LETTER MUST BE ON OFFICIAL DEPARTMENT LETTERHEAD

PURCHASING OFFICER STATEMENT

I hereby solemnly swear that I am not prohibited from possessing firearms or high

capacity magazines, pursuant to the Violent Crime Control & Law Enforcement Act of

1994, and that I have not been a patient in a mental hospital within the last 5 years.

The firearm and/or high capacity magazines being purchased are for use in the performance

of official duties, and are not being acquired for personal use or for purposes

of resale or transfer.

I declare, under the penalty of perjury, that the above statement is true and accurate.

__________________________________                         ___________________

Signature of Purchasing Officer                                                                  Date

SUPERVISOR STATEMENT

Under penalty of perjury, I certify that:

______________________________________________________________________

Name of Purchasing Officer                                     Drivers License # or SS #                   Badge #

I declare, under penalty of perjury, that the information contained in this statement is

true and correct. The firearm and/or high capacity magazines described herein are

intended for use by the acquiring officer while engaged in the performance of official

duties and the officer is therefore allowed to purchase the equipment through this

department. The purchasing officer is acquiring the firearm and/or magazines for use

in the performance of official duties, not for purposes of resale or transfer.

LAUTENBERG CERTIFICATION - I further certify a criminal records check has been conducted

on this officer which shows no convictions for misdemeanor crimes of domestic

violence. I also certify that I am allowed to authorize the acquisition of the firearm

and/or magazines.

Item(s) to be purchased:______________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature of Chief Administrator or Designee                                                       Title/Rank Date

Send to: RB Precision PO Box 96 Preemption IL 61276