Ninilchik, AK  99639

Fax 907-567-4475

Firearms Statement & Release From Liability

Very Important - Please Note
WHEN ORDERING ALL FIREARMS, YOU MUST COMPLETE THIS STATEMENT, AND RETURN BY MAIL OR FAX TO US BEFORE WE CAN SHIP YOUR ORDER.

I hereby certify that I am a citizen of the United States and that I have never been convicted in any court of the U.S., its territories or the District of Columbia for commission of a crime of violence as defined in the Federal Firearms Act nor for commission of a crime punishable by imprisonment for a term exceeding one year; (nor am I at present under indictment in any such court for such crimes); nor am I a fugitive from justice as defined in such act.  I am over 21 years of age, of sound mind, am not a drug addict nor a habitual or adjudged drunkard.  I further certify that I am not under any such legal disability that  would prohibit Dale C. Anderson, or Debra P. Anderson from selling and shipping to me the firearm(s) that I am ordering herein; nor are there any laws in my state, county or city that prohibit my legally acquiring this firearm.  I understand that the firearm(s) I am ordering ARE BEING SOLD AS COLLECTORS ITEMS ONLY, and that Dale C. Anderson, or Debra P. Anderson can not and does not guarantee their ability to function as a firearm nor do they accept responsibility for their shooting safety.  I further understand that I should never attempt to operate or fire any used or antique firearm before having it checked and certified safe and operational by a qualified gunsmith.