EXHIBIT_03C__PISTOL_QUALIFICATION_RECORD.pdf
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- TIRMS-16-R-00001
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EXHIBIT 3C - PISTOL QUALIFICATION RECORD
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EXHIBIT 3C
PISTOL QUALIFICATION RECORD
Name (Last, First, MI) Social Security Number
Weapon: ______ _________ _____________ (Make, Model, Serial # )
Distance Stage Position Rounds Score
1 1/2 Yds 1 FI Stance 6 5 x _____ =
4 x _____ =
3 x _____ =
2x_______
Total =
3 Yards 1 Shooting Stance 6 5 x _____ =
4 x _____ =
3 x _____ =
2x_______
Total =
7 Yards 1 Shooting stance 24 5 x _____ =
4 x _____ =
3 x _____ =
2x_______
Total =
15 Yards 2 Standing /Kneeling 12 5 x _____ =
4 x _____ =
3 x _____ =
2x_______
Total =
25 Yards 2 Standing /Kneeling 12 5 x _____ =
4 x _____ =
3 x _____ =
2x_______
Total =
Qualified: YES NO FINAL SCORE:
IRS Verifying Official (Signature) (Date) Range Officer (Signature) (Date)
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