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LICATION FOR LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CERTIFICATE OF FIREARMS PROFICIENCY NOTE: This certification is valid for Arizona residents only (USC Title 18, Chapter 44, Section 926C(d)2(B)). Resident is defined under ARS 28-2001. TYPE OR PRINT LEGIBLY - USE CAPITAL LETTERS USE BLACK INK ONLY Please read the instructions on page two of this application. LEGAL NAME: (Last, First, Middle) INITIAL RENEWAL RESIDENCE ADDRESS: (Street # and name including apartment / L.

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