SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT/RESPONDENT FOR COURT USE ONLY PROOF OF SALE OR SURRENDER OF FIREARM(S) CASE NUMBER Instructions: When you sell or surrender your firearm(s) under a court order, ask the licensed gun dealer or law enforcement agent to complete item 2a or 2b. After the form is signed, file the original completed form with the court. Keep a copy for your records. Note that firearm(s) must not be loaded when surrendered. Additionally note that firearm(s) may not be brought into the courthouse nor surrendered directly to the court. 1. Defendant or Respondent (name): has a. sold to a licensed gun dealer b. temporarily stored with a licensed gun dealer c. turned over to law enforcement the firearm(s) described in item 3. 2. The firearm(s) described in item 3 were sold, temporarily stored, or surrendered as follows: To be completed by licensed gun dealer a. SALE b. TEMPORARY STORAGE OF FIREARM(S) - LICENSED DEALER The firearm(s) listed in item 3 were sold temporarily stored: (1) On (date): (2) At (time): a.m. p.m. (3) To (name of licensed gun dealer): (4) License #: (5) Address: (5) Phone: I declare under penalty of perjury under the laws of the State of California the information above is true and correct. Date: Type or print name/Title To be completed by law enforcement agent Signature c. SURRENDER OF FIREARM(S) TO LAW ENFORCEMENT The firearm(s) listed in item 3 were sold: (1) On (date): (2) At (time): a.m. p.m. (3) To (name and title of law enforcement agent): (4) Name and address of law enforcement agency: I declare under penalty of perjury under the laws of the State of California the information above is true and correct. Date: Type or print name/Title Signature FIREARM(S) SOLD, SURRENDERED OR TEMPORARILY STORED 3. The firearm(s) sold, surrendered or temporarily stored as indicated above were the following: Firearm Make Model Serial Number (1) (2) (3) (4) (5) Additional firearm(s) as listed on attachment to this form. (The make, model, and serial number of each firearm must be provided.) 4. The firearm(s) listed in item 3 are: a. All b. Some of the firearms that the defendant or respondent owned, possessed, or controlled. If the latter, all of the defendant's or respondent's other firearms: (1) Have been sold or transferred and proof was previously filed with this court on (date): (2) Have been sold or transferred and proof of sale or transfer is filed concurrently with this proof. (3) Have not yet been sold or transferred (explain): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or print name SDSC CRM-211 (Rev. 3/14) Optional Form Signature PROOF OF SALE OR SURRENDER OF FIREARM(S) American LegalNet, Inc. www.FormsWorkFlow.com