DEPARTMENT OF THE TREASURY

BUREAU OF ALCOHOL, TOBACCO AND FIREARMS

EXEMPTION CERTIFICATE

(For use by State and local governments (Section 4221(a)(4) of the Internal Revenue Code)

  Date: _______________________, 19_________.

  I, hereby certify that I am  ___________________________________________________

                                                                        (Title of Officer)

of ______________________________________and that I am authorized to execute this certificate.

                (State or local government)

Check applicable type of certificate:

o    The article or articles specified in the accompanied order.

o        All orders placed by the purchaser for the period commencing __________________________

                                                                                                                                         (Date)

and ending ____________________ (period not to exceed 12 calendar quarters), are, or will be purchased

from Weapons Unlimited for the exclusive use of ____________________________________ of

                                                                                                  (Governmental Unit)

 ______________________________.

           (State or local government)

I understand that the exception from tax in the case of sales of articles under this exemption certificate to a State, etc. is limited to the sale of these articles purchased for its exclusive use.  I understand that fraudulent use of this certificate for the purpose of securing this exemption will subject me and all parties making such fraudulent use of this certificate to all applicable criminal penalties under the Internal Revenue Code.

 

 

SIGNATURE                                                                                                                             DATE

 

AGENCY       

 

ADDRESS

 

CITY                                                                        STATE                                                               ZIP CODE