GENERAL AFFIDAVIT

State of _______
County of ________________

BEFORE ME, the undersigned Notary, ___________________________________________________ [name of Notary before whom affidavit is sworn], on this _________________ [day of month] day of _________________ [month], 20____, personally appeared _________________________ [Name of affiant] known to me to be a credible person and of lawful age, who being by me first duly sworn, on his oath, deposes and says:

The Blank Only Replica(s) being purchased from Schoessler’s Supply Room, LLC is/are being purchased for the use in historical theatrical re-enactor, theatrical, movie, or television industry only.  Further, it is understood that in purchasing the replica, I am waiving Schoessler's Supply Room of all liabilities resulting from its use or misuse.
“Blank Only” Replicas are not guns, however they are not toys either. Every precaution will be taken to ensure the replicas are used in a safe and lawful manner.

__________________________________
[signature of affiant]

 Printed Name __________________.
 Adress______ __________________

 City, State, Zip ___________________

Subscribed and sworn to before me, this _________________ [day of month] day of _________________ [month], 20____.

[Notary Seal:]

__________________________________
[signature of Notary]

__________________________________
[typed name of Notary]

NOTARY PUBLIC

My commission expires: ________________, 20____.