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The firearm(s) are the property of the department and will be used by duly sworn officers of this department in the performance of their duties as law enforcement officers only. Signature of Highest Ranking Officer in the Department |
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| Printed Name: | * |
| Title: | * |
| Name of Agency: | * |
| Physical Address: | * |
| City: | * |
| State: | * |
| Zip: | * |
| * All Fields Are REQUIRED. | |