NHJB-2055-DF (07/01/2013) Page 1 of 1 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) PNO: MOTION AND AFFIDAVIT FOR RETURN OF FIREARMS Pursuant to RSA 173-B, RSA 633:3-a, or 169-C V. Plaintiff Defendant Def Date of Birth NOW COMES the defendant, , and respectfully represents and requests the following: 1. Pursuant to a Domestic Violence/Stalking Protective Order, or violation of a 169-C Stay Away Protective Order, my firearms(s) and/or ammunition was/were relinquished to: Police Department State Police Troop/Unit Fish & Game County Sheriff's Department 2. The Order has expired or will expire on and I would like return of my firearm(s) and ammunition. 3. I have no other outstanding civil protection orders issued against me, nor bail orders, and I have not been convicted of any misdemeanor or felony offenses in any state or federal court which would make it unlawful for me to possess any firearm and ammunition pursuant to the Gun Control Act of 1968, as amended, nor am I under any other legal status that would render my possession of a firearm or ammunition illegal. 4. My date of birth is , and I was born in the State of 5. My current address and telephone number are: 6. Race: White Black American Indian/Alaskan Native Asian or Pacific Islander Unknown 7. Physical Description: a. Eye Color c. Height (feet) (inches) b. Hair Color d. Weight (pounds) 8. I request a search of all pertinent records by the New Hampshire Department of Safety. 9. I request a hearing on my motion. Date Signature of Defendant State of , County of This instrument was acknowledged before me on by My Commission Expires Affix Seal, if any Clerk of Court/Deputy Clerk/Justice of Peace/Notarial Officer American LegalNet, Inc. www.FormsWorkFlow.com