| Document Date: 2012-01-19 19:45:52
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City Norcross / / Company L Safety Systems / R Voluntary / / / Event Man-Made Disaster / / Facility Never store / / IndustryTerm metal barrel thimbles / metal fiber optic sights / safety systems / gas seal / tight gas seal / / Organization Assembly for Cleaning and Maintenance / National Muzzleloading Rifle Association / / Person Optima Pro / / / Position Illuminator / local sporting goods dealer for information on the courses available / General / competent gunsmith / certified hunter / / ProvinceOrState California / Georgia / / Technology Fiber Optic / / URL www.cva.com / /
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Break-Action Model No. ____________ Serial No. ________________ Caliber _______________