Qualification Checklist for Ceremonial Rifles
Qualification Checklist for Ceremonial Rifles
Law Enforcement Agencies
❑ Written request signed by the agency chief addressed to:
US Army TACOM Life Cycle Management Command
ATTN: AMSTA-LCL-IWD, M/S: 419D
6501 E. 11 Mile Road
Warren, MI 48397-5000
The Agency Chief may designate, in writing, a command staff officer the authority to obligate the agency with respect to all matters pertaining to these weapons.
Please complete the following questionnaire and return this form with the other required documents outlined below:
Full Name of Organization: _____________________________________________
Organization Address: _________________________________________________
City:__________________________ State: ____________ Zip Code: ___________
Telephone Number: ___________________FAX Number: ____________________
Organization E-mail Address:____________________________________________
Name of Point of Contact: ______________________________________________
POC Mailing Address (if different than above): _____________________________
City: __________________________ State: ____________ Zip Code: __________
Telephone Number: _________________________FAX Number: ______________
E-mail Address: ______________________________________________________
Number of Active Police Personnel: ______________________________________
Number of Honor Guard Members: _______________________________________
Number of Rifles You Currently Have (complete attached inventory form): ______
Number of New and/or Replacement Rifles Required: ________________________
Shipping Address for the new rifles (cannot be a private residence or post office box):
Business Name: ____________________________________________________
*****MUST BE OPEN DURING NORMAL BUSINESS HOURS*****
Street Address: _____________________________________________________
City: ______________________ State: _____________ Zip Code: _____________
Business Hours: ___________________________
All documents outlined below must be signed by the agency chief or the designated Command Staff Officer. All documents must have original signatures and notary endorsement.
❑ Certificate of Arms Storage (enclosed) – This certificate identifies the storage location of the weapons.
❑ Affidavit of Compliance with Title 10 USC §4683 (enclosed) – This form identifies the intended use of the ceremonial weapons as required by law.
❑ Ceremonial Rifle Inventory (enclosed) – If your organization currently has or was issued ceremonial rifles in the past, you must complete this form.
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