Notice of Ineligibility to Possess Firearm (NTIPF) - Page 1 of 1 CrRLJ 07.0800 - (6/2018) RCW 9.41.040 C ourt of Washington For Plaintiff vs. Defendant. No. Notice of Ineligibility to Possess Firearm (NTIPF) To the Defendant: You have been convicted of one or more of the following crimes committed against a family or household member: Fourth Degree Assault Coercion Stalking Reckless Endangerment Criminal Trespass in the First Degree Violation of a Protection Order or No-Contact Order Harassment committed on or after June 7, 2018. You must immediately surrender any firearm and any concealed pistol license. You may not possess, own or have under your control a firearm, and under federal law any firearm or ammunition or a concealed pistol license until your right has been restored by the court of record that ordered the prohibition on possession of a firearm or the superior court where you live, and by a federal court if required. Violation of these laws is a felony. This document has been read to the defendant. Dated: Defendant222s Signature Judge/Commissioner/Pro Tem Defendant222s Last Name First Name Middle Name List any aliases Residential Street Address City State Zip Date of Birth (month/date/year) Driver222s License/ID Number Race Sex Weight Height Eyes Hair Court NCIC # Submit to: Dept. of Licensing, Business & Professions Firearms Unit, firearms@dol.wa.gov , (PO Box 9649, Olympia, WA 98507-9649). American LegalNet, Inc. www.FormsWorkFlow.com