ency: Printed Name/Agency: Reason. Reason: Relinquished Custody Date and fl ue Accepted Custody Date ad Tan Signature: Signature: Printed Ntune/Agcnc): Printed Name/Agency: Reason: Reason: Firearm Certification by (RUMAT) / Explosive Materia Certification by (SART): Primed Name: Signature: D