Ammunition Statement:
-Rifle & shotgun ammunition and magazines, I certify that I am at least 18 years of age
-Pistol ammunition and magazines, I certify that I am at least 21 years of age
I ______________________, certify that:
- No federal, state or local law prohibits me from purchasing, possessing or being shipped the ammunition, magazines, or other regulated items.
- Have not been convicted in any court of, a crime punishable by imprisonment for a term exceeding one year.
- I am not a fugitive from justice.
- I am not an unlawful user of or addicted to any controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)).
- I have not been adjudicated as a mental defective or who has been committed to a mental institution.
- I am not an alien illegally or unlawfully in the United States.
- I have not been discharged from the Armed Forces under dishonorable conditions.
- Having been a citizen of the United States, have not renounced his citizenship.
- I have not been convicted in any court of a misdemeanor crime of domestic violence.
- I am not subject to a court order that:
-- as issued after a hearing of which such person received actual notice, and at which such person had an opportunity to participate;
-- restrains such person from harassing, stalking, or threatening an intimate partner of such person or child of such intimate partner or person, or engaging in other conduct that would place an intimate partner in reasonable fear of bodily injury to the partner or child; and
- includes a finding that such person represents a credible threat to the physical safety of such intimate partner or child; or
- by its terms explicitly prohibits the use, attempted use, or threatened use of physical force against such intimate partner
- or child that would reasonably be expected to cause bodily injury.
Signed: ________________________________
Printed Name: __________________________
Date: ________________________________
***False Submissions of personal information to the above statement or failure to submit Proof of age (Driver Lic / FOID) after sale/payment will cause the sale to be voided.
*Scan-eMail or Mail Documents.