SUPERIOR COURT OF CALIFORNIA, COUNTY OF AMADOR 500 Argonaut Lane, Jackson, CA 95642 (209) 257-2603 Petitioner/Plaintiff: Respondent/Defendant: DECLARATION OF RESTRAINED PERSON RE: FIREARMS CLERK'S USE ONLY Case No. I, ____, am the restrained person in the above entitled action. [IF YOU DO NOT HAVE ANY FIREARMS IN YOUR POSSESSION] 1) initials I hereby declare that I do not possess firearms of any kind. Furthermore, I understand that I am prohibited from owning, possessing, purchasing or receiving a firearm while the restraining orders are in effect, pursuant to Family Code §6389. [IF YOU DO HAVE FIREARMS IN YOUR POSSESSION] 2) initials I understand that I must surrender to local law enforcement or sell to a licensed gun dealer any firearm in or subject to my immediate possession or control within 24 hours after issuance of this order. I also understand that I must file a receipt with the court showing compliance with this order within 48 hours of receiving this order. Failure to timely file a receipt demonstrating relinquishment shall constitute a violation of the protective order. Furthermore, I understand that I am prohibited from owning, possessing, purchasing or receiving a firearm while the restraining orders are in effect, pursuant to Family Code §6389. I declare, under penalty of perjury under the laws of the State of California, that the foregoing is true and correct. Dated: Signature of Declarant/Restrained Party Rev. 05/14/01 Firearms Declaration FCS006 American LegalNet, Inc. www.FormsWorkflow.com