TO: FROM: Indiana State Police, Firearms Section ______________________Court ______, (_____________ Division, Room ______) DATE: RE: ____________________ _____________________________ vs. _____________________________ Case Number__________________________________ Respondent Date of Birth Respondent SSN Name(s) of Petitioner(s): _________________ __________________ __________________________________ __________________________________________________________ This is to advise you that on the ________ day of _______________, 20____, the Court issued an Order for Protection against the above-named Respondent, _________________________, prohibiting the use, attempted use, or threat of physical force and/or finding, inter alia, that she/he posed a credible threat to the safety of ________________________, the Petitioner, an intimate partner within the meaning of the federal firearms laws, 18 U.S.C. §922 (g) (8). The Respondent, ________________________________, states that she/he does/does not possess a license to carry a handgun. COPIES TO: INDIANA STATE POLICE, FIREARMS SECTION, FAX No. (317) 232-0652 RESPONDENT TCM-PO-0114 Approved 07/02 Rev. by State Ct. Admin. 07/03 American LegalNet, Inc. www.FormsWorkFlow.com