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 Co., 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 Co., 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.