(Must be on Departmental Letter Head)

Sample Letterhead
Dear Baton Rouge Police Supplies,

This is to acknowledge that the undersigned agrees and understands, under penalty of perjury, that

_______________(name of officer) is authorized to purchase a _______ (type of handgun
/Make and model) handgun
and/or ____(quantity) High capacity magazines. I certify under penalty of perjury this handgun and these
magazines(s) will be used for Law Enforcement use only and not for resale. The Authorized officer also agrees to
these restrictions as evidenced by the counter signature at the bottom of this letter. For purposes of this letter, high
capacity magazine are defined as magazines having more than ten rounds capacity for the caliber of rounds intended
for that particular magazine.

This furthermore states that the officer who is purchasing this firearm has not been convicted of a felony nor been
arrested of convicted of a misdemeanor domestic violence act.


Sincerest regards,



Must be singed by the Sheriff or Chief of Police
(Name and Title)


Authorized officer counter signature