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' ~ VALUABLE METAL DEALER REPORT <br />(COPPER, BRASS AND ASSOCIATED ALLOYS) <br />P Date of Purchase ............................................................ <br />l <br />t Firm Name of Buyer ....................................................._....... <br />....... County ....................................... <br />Address .......:....... ......................................_.......----•---................_. <br />.......................... Street <br />...:.............................•.........---...............................---.......---....... Zip <br />City State <br />Place of Purchase .............................................:.........................._....... <br />-•~~ ••~•~-• If Different Than Above <br />Person(s) Selling Valuable Metal: List Additional Persons on Back of Form. <br />1. Name ..............................................................•--.................. Date of Birth................................... <br />Address . ................_......................................................_....... <br />....................................... . <br />- Street <br />...........................................•--...........-......... State Zip <br />City <br />Driver License or Social Security Number....._ ..............••---•--••••---•-------••-•••••-•-----•••-•••••••....°'°--'°""'..°'-••°"' <br />Vehicle Used to Deliver Valuable Metal <br />Year.......--••----- Make ................ Model.-.............. Color ........-•---... License No............................................. <br />Weight of Meta1 ................................................................Lbs. Price Paid $..................-......................................... <br />Description of Metal: ..._ .............................._....................._...__ <br />Signature of Person Making Purchase <br />This copy to be retained by the dea/er for a period of two (2l years and shat! be made <br />available for inspection by any law enforcement official of any time. <br />415 _ _ _ __ <br />