Superior Court of Washington
For
______
Petitioner DOB
vs.
______
Respondent DOB / NO.
Order to Surrender Weapon
ORWPNP (CPL Restriction)
ORWPN (No CPL Restriction)
(Clerk's Action Required)

This matter came on regularly before the court on a Petition for Surrender of Weapon. Based upon the petition, testimony, and the relevant case record, the court finds:

By a preponderance of evidence that:

Possession of a firearm or other dangerous weapon by the respondent presents a serious and imminent threat to public health or safety, or to the health or safety of any individual.

By clear and convincing evidence that Respondent:

Has used, displayed, or threatened to use a firearm or other dangerous weapon in a felony.

Previously committed an offense making him or her ineligible to possess a firearm under RCW 9.41.040.

Other findings: ______

______

______

That the relationship of the parties is:

spouse or former spouse*
parent of a common child *
current or former cohabitant as intimate partner, including current or former registered domestic partner* / current or former dating relationship
stepparent or stepchild
current or former cohabitant as roommate / in-law
parent or child
blood relation other than parent or child

And it is ordered that the respondent :

(Strike out any restriction that does not apply)

·  Shall surrender all firearms and other dangerous weapons in your possession or control, including but not limited to, those listed in the table, below, and file proof of surrender within 5 business days of being served this order:

Firearms and Other Dangerous Weapons

Attach sheet if there are more to list.

Surrender firearms and other dangerous weapons to:

the Sheriff of ______County

the Chief of Police of the City of ______

respondent’s attorney, Name: ______WSBA No. ______

Other, Name:______

Relationship to Respondent: ______

·  Shall surrender any concealed pistol license issued under RCW 9.41.070 to the same person or agency listed above.

·  Is prohibited from obtaining or possessing a firearm or other dangerous weapon or concealed pistol license.

If the respondent has previously surrendered firearms, other dangerous weapons and concealed pistol license, they shall remain in the possession of the recipient until further order of the court.

The Law Enforcement Officer serving this order is authorized to confiscate Respondent's weapons at the time of service.

WACIC Entry
The Clerk of Court shall forward a copy of this order on or before the next judicial day to the ______County Sheriff's Office or ______City Police Department where petitioner lives which shall enter this order in the Washington Crime Information Center computer.
Service
______County Sheriff's Office or ______City Police Department where respondent lives which shall personally serve the respondent with a copy of this order and shall promptly complete and return to this court proof of service.
Respondent appeared in court. Additional service is not required.

Dated ______at ______a.m./p.m. ______

Judge/Commissioner

Presented by: I acknowledge receipt of a copy of this order.

______

Petitioner Date Respondent Date

Or to Surrender Weapon (ORWPNP,ORWPN) - Page 1 of 2

WPF DV-4.040 (06/2012) - RCW 9.41.800