DEPARTMENT OF THE TREASURY
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
(For
use by State and local governments (Section 4221(a)(4) of the Internal Revenue
Code)
(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