Yourtown Police Department

P.O. Box BR549

Yourtown, USA 11879

Chief John Smith

( DATE)

Parro's Gun Shop & Police Supplies Inc.

95 US RT 2

Bolton Road

Waterbury, VT 05676-9405

Dear Sir:

This letter is to acknowledge that the undersigned agrees and understands, under penalty of perjury, that _______________employed as a ____________________

with this department, is authorized to purchase/use the _____________________

Bushmaster Rifles. It is acknowledged that in accordance with the Violent Crime Control and Law Enforcement Act of 1994, (1) this officer is employed by a Government agency, (2)the officer is a peace officer under Federal or State law, and (3) the officers duties require the possession of the weapon or ammunition feeding devices. This firearm/large capacity ammunition feeding device will be for law enforcement duty use only and is suitable for use in performing these official duties and is not being acquired for personal use or for purpose of transfer or resale. For the purpose of this letter, large capacity feeding are defined as a belt, drum, feed strip, or similar device for a firearm manufactured after September 13, 1994, that has a capacity of , or that can be readily restored or converted to accept more then 10 rounds of ammunition.

The authorized officer also agrees to these restrictions as evidence by the counter signature at the bottom of this letter.

___________________________________ _____________________________________

(Chief) ( Sheriff) ( Station Commander) Purchasing Officer

( Signers named typed out) (Purchasing officers name typed)

(officers rank, title)

( LETTERS MUST BE ON ORGINAL LETTERHEAD, NO FAXES OR COPIES)