COURTS OF ARIZONA - NAME OF COURT Plaintiff: Date of Birth: -vsDefendant: Street Address Court Case No.: Court No., NCIC: Court No., DPS: City, Arizona Zip Code Phone Number NOTICE TO SHERIFF OF BRADY DISQUALIFICATION Notice is hereby given to the Sheriff of this County that the Order of Protection (“protection order”) issued in the above-referenced case on (date) meets the criteria established in the Violent Crime Control and Law Enforcement Act of 1994 (18 U.S.C. 922(d) and (g)) and should be assigned a positive Brady Record Indicator in the Protection Order File of the National Crime Information Center database. The Defendant is disqualified from purchasing or possessing a firearm or ammunition based upon the following: 1. The protection order was issued or affirmed after a hearing of which the Defendant received actual notice and at which the Defendant had an opportunity to participate. 2. The Defendant is a person subject to a protection order that restrains such person from harassing, stalking, or threatening an intimate partner of such person or child of such intimate partner or person, or engaging in other conduct that would place an intimate partner in reasonable fear of bodily injury to the partner or child. As defined in 18 U.S.C. 921(a), “intimate partner” means with respect to a person, the spouse of a person, a former spouse of the person, an individual who is a parent of a child of the person, and an individual who cohabitates or has cohabited with the person. 3. The protection order includes a finding that the Defendant represents a credible threat to the physical safety of such intimate partner or child; or by its terms explicitly prohibits the use, attempted use, or threatened use of physical force against such intimate partner or child that would reasonably be expected to cause bodily injury. The protection order issued by this Court remains in full force and effect and was not modified at the hearing held. Date: Approved: July 2001 Judicial Officer: Notice to Sheriff of Brady Disqualification: A.R.S. 13-3602(G)(4); A. O. 98-70 American LegalNet, Inc. www.USCourtForms.com