(AGENCY
LETTERHEAD HERE)
Date:
Kings Gun
Center
520 W Lacey Blvd
#6
Hanford, CA 93230
Re: Firearm(s) Purchase
Authorization in Lieu of Federal Form 4473 or 5300.35 and
NICS
Compliant Record Check of Officer
(Officer
Name)
TO WHOM IT MAY CONCERN:
I hereby certify that the
above-named law enforcement officer will use the requested
firearm(s) for
use in performing official
duties. I further certify that a records check has been conducted
on the
law enforcement officer who is
purchasing the firearm(s) and reveals no conviction
for
misdemeanor crimes of domestic
violence.
Additionally, the above law enforcement
officer is a full time compensated law enforcement
officer
(qualifies under California
Penal Code 830.1).
Please Waive the 10-day waiting period per
California Penal Code 27650
The firearm(s) to be purchased is/are
listed below:
Make _(type not handwrite)____________ Model
___(type)___________ Caliber ___(type)________ Serial #
_____(type)________________
Firearm Description
Name (typed)
Signed
_________________________________________________________ Date
__________________
Typed Name of Purchasing Officer Signature Date
Name (typed)
Signed
_________________________________________________________ Date
__________________
Typed Name of Person of Authority Signature
Date (see notes below)
Officers
Name:
C/O Agency Name: (type)
Agency Address: *(type)
Agency City, State, Zip Code: (type)
KGC03/13
A) In a city or county
police department the director of public safety or the
chief or commissioner of police.
B) In a Sheriff’s office,
the sheriff.
C) In a State police or highway
patrol department, the superintendent or the supervisor in
charge of the office
to which the state
officer or employee is assigned.
D) In Federal law enforcement
offices, the supervisor in charge of the office to which
the state officer or
employee is
assigned.
INSTRUCTIONS FOR FIREARMS WITH HICAP
MAGAZINE LETTER ( also Assault Weapons )
1) It is a requirement that the
Authorization Letter be printed on official agency
letterhead.
2) Original signatures are
required, no rubber stamps or copies are permitted
3) Original documents are
required when placing an order no fax copies will be
accepted.