OFP108 State ENG Rev 07/15www.mncourts.gov/formsPage 1 of 2THIS DOCUMENT SHALL BE SEALED UPON FILING WITH THE COURTState Of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Domestic Abuse Petitioner (first, middle, last)and Respondent (first, middle, last)Affidavit / Proof of Transfer of Firearms I, , state the following: On, the Respondent named above the following law (Date firearms were transferred/received) enforcement agency:, (name of agency) permanently or temporarily transferred the firearms identified below to me(check one below) a person who may lawfully receive firearms and does not live with the Respondent. I a law enforcement agent with the following agency a federally licensed firearms dealer, FFL #acknowledge that I may be held criminally and civilly responsible under Minn. Stat 247 624.7144 if the Respondent named above gains access to a transferred firearm while the firearm is in my custody. American LegalNet, Inc. www.FormsWorkFlow.com OFP108 State ENG Rev 07/15www.mncourts.gov/formsPage 2 of 2THIS DOCUMENT SHALL BE SEALED UPON FILING WITH THE COURT List the name, make, model and caliber of all firearms transferred in the table below: Firearm Name / Make Serial Number Model / Caliber 1. 2. 3. 4. 5. 6. 7. If the Respondent transferred the firearms, the Respondent must file this Affidavit/Proof of transfer with the court within two business days of the firearm transfer. If a law enforcement agency transferred the firearms, the law enforcement agency transferring the firearms must file this Affidavit/Proof of Transfer with the court within two business days of the firearm transfer. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. 247 358.116. Dated: Signature Name: Address: Telephone: E-mail address: Agency or Business Name, if applicable: City/State/Zip: County and State where signed American LegalNet, Inc. www.FormsWorkFlow.com