CERTIFICATE OF ULTIMATE PURCHASER


(Date) ______________/_____________, 19 _____.


I, hereby certify that I am _________________________________________________________ of the
                              (Title of the authorized purchaser: Please print name)

__________________________________________ and That I am authorized to execute this certificate:
     (State or local government)

And that the article or articles specified in the Accompanying order are, or will be, purchased from

__________________________________________________________________________________
              (Vendor/Dealer listed on the departmental PO or order)

for the exclusive use of ________________________________________________________________
                                 (Agency ordering the weapons Ultimate purchaser)

of the _____________________________________________________________________________.
               (State or local government in Charge of the ordering agency).

The undersigned understands that the fraudulent use of this statement may subject the Undersigned or
any other party. Making such fraudulent use to all applicable criminal penalties under The Internal
Revenue Code. The undersigned agrees to notify the man Manufacturer/importer it the article is not in fact
used as Specified in the certificate. The following weapons will be used for Law Enforcement use only.

__________________________________________________________________________________.
                 (Description Of Weapons ordered and Quantity )

Signature: ______________________________________________________________________

Address: ______________________________________________________________________

City: __________________________ State: ______________ Zip: _________

Phone: ________ / _______ - __________ Fax: ________ / _______ - ________


Please mail original To:
Florida GunWorks
8306 Mills Drive, #571
Miami, FL 33183