Federal Excise Tax Exemption Certification

(For use by States and local governments (section 4221(a)(4) of the Internal Revenue Code).

Date_______________________, 2___________

I, hereby certify that I am_____________________________________(title)

of _________________________________,(state or local government) and

that I am authorized to execute this certificate and that all orders placed by the

purchaser for the period commencing_______________________(*date) and

ending _____________________(*date)(period not to exceed 12 calendar

quarters), are, or will be, purchased from Fiocchi Ammunition/Gulf States

Distributors for the exclusive use of _________________________________

(government unit) of _________(state of local government).

I understand that the exemption from tax in the case of sales of articles under this exemption certificate to a State, etc., is limited to the sale of articles purchased for its exclusive use. I understand that fradulent use of this certificate for the purpose of securing this exemption will subject me and all parties making such fradulent use of this certificate to all applicable criminal penalties under the Internal Revenue Code.

Signature__________________________
Shipping Address ________________________________

________________________________

*Certificate Valid for Three Years

DO NOT FAX-MUST HAVE ORIGINAL SIGNATURE.
Return form via mail with original signatures to:

Gulf States Distributors
6000 E Shirley Lane
Montgomery AL 36117