FEDERAL EXCISE TAX EXEMPTION FORM

Instructions: Print this form, complete it (requires one signature), and turn it in with your purchase request. If you have any questions please contact us. Thank you.

(For use by states, territories, or political subdivisions thereof, or the District of Columbia) CERTIFICATE OF ULTIMATE PURCHASER Date:  _________________ I hereby certify that I am the _________________________ (Title of Officer) of the _______________________________________ (name of government entity) and that I am authorized to execute this certificate; and that the articles specified in the accompanying order are, or will be procured from, Spreadfire Arms, Austin, Texas, and _____________________________________ (name of manufacturer/importer of weapons) for the exclusive use of the _______________________________________ (name of law enforcement agency) at ___________________________________________________________________ (law enforcement agency address). 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 manufacturer/importer if the article is not in fact used as specified in this certificate. The following weapons will be used for law enforcement use only: __________________________________________________________   __________________________________________________________ __________________________________________________________ (list weapons or ammunition ordered and quantity) Signature: _____________________  Title: ________________ Address:  ______________________________________________ __________________________________________________________ __________________________________________________________ Delivery date:  90-180 days from receipt of order * Failure to complete this form will result in the application of  Federal Excise Tax (11%) to your order.

ASSOCIATED LINKS: LAW ENFORCEMENT PURCHASERS: Click here to view an example of a police demonstration letter. Click here to view an example of a "Law Enforcement Only" high-capacity magazine affidavit. Click here to view an example of a Law Enforcement "Official Use" Letter. Click here to view an example of a "Law Enforcement Only" individual officer semiauto assault weapon letter. Click here to view an example of a "Law Enforcement Only" armor piercing ammunition letter. Click here to contact us.