Form Ttb F 5300.28-Application For Registration For Tax-Free Transactions Under 26 U.s.c. 4221 Page 2

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8. THE SUPPORTING INFORMATION (item 7) IS CONTAINED IN (Check applicable boxes and enter appropriate information.):

Pages numbered ____ through ____ attached to this application.

Information on file with the Alcohol and Tobacco Tax and Trade Bureau as part of the application for:

Certificate of Registry Number _________________________________.

Other Application Approved by the Alcohol and Tobacco Tax and Trade Bureau:

Federal Firearms License Number ______________________________.

Type of application: _______________________________

Permit or license number ____________________________

The applicant incorporates this information as part of this application. If the applicant sends any other information for this application, it is also part of this

application.

9. AFFIRMATION BY APPLICANT

I affirm that this Certificate of Registry will be used as specified in applicable provisions of laws and regulations, and I understand that

misuse of this Certifcate will lead to its revocation and/or the penalties provided by law. I agree to maintain records in compliance with

applicable laws and regulations. These records will be available to an authorized employee of the Alcohol and Tobacco Tax and Trade

Bureau. Also, I agree to report to the Bureau any change in my name or principal place of business and in business ownership or control,

within 30 days of such change. Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge

and belief, it is true, correct, and complete.

9a. SIGNATURE OF APPLICANT OR PERSON AUTHORIZED TO SIGN FOR APPLICANT

9b. TITLE OF APPLICANT OR PERSON AUTHORIZED TO SIGN FOR APPLICANT

9c. DATE

10. ALCOHOL AND TOBACCO TAX AND TRADE BUREAU APPROVAL