Superior Court of Washington
For
Petitioner
vs.
Respondent / No.
Temporary Order to Surrender Weapon and Notice of Hearing
(ORWPN/ORH)
(Clerk’s action required)
Next Hearing Date/Time:______
At: ____________

Having received the petitioner’s Petition to Surrender Weapon,the Courtorders the following:

Because a showing has been made that irreparable injury could result if an order is not issued immediately without notice to the other party, it is ordered that:

Respondent shall immediatelysurrender all firearms and other dangerous weapons and file proof of surrender within 5 business days of being served this order. Surrender firearms and other dangerous weapons to:

the Sheriff of ______County;

the Police department of the City of ______;

respondent’s attorney,name: ______WSBANo. ____;

Other, name:______,

relationship to respondent:______

who shall keep them until further order of the court.

If the recipient named above agrees to accept responsibility for respondent’s firearms and dangerous weapons, the recipient shall complete a proof of receipt of firearm or other dangerous weapons on aform approved by the court. The respondent must file proof of compliance with this order with the clerk of the court.

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

The following is a list of firearms or other dangerous weapons known to be in the possession of the respondent:

Type or weaponLocation

______

______

______

______

WACIC Data Entry
It is further ordered that the Clerk of Court shall forward a copy of this order on or before the next judicial day to:
County Sheriff's Office or City Police Department where the petitionerlives which shall enter this order into the Washington Crime Information Center computer system.
Service
County Sheriff's Office or City Police Department where respondent lives which shall personally serve respondent with a copy of this order and shall promptly complete and return to this court proof of service.
The petitioner shall make private arrangements for service of this order.
The respondent appeared and was informed of the order by the court; further service is not required.

It is ordered that a hearing will be held as noted on page 1 to determine whether the petition for surrender of weapons should be granted for a longer period of time or the weapons returned to respondent. If you do not appear, the court may enter an order granting the requested relief.

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

Judge/Commissioner

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

______

PetitionerDateRespondent Date

Temp Or Surrender Weapon/Nt of Hrg ((ORWPN/ORH) -Page 1 of 1

WPF DV-4.035 (06/2012) – RCW 9.41.800