1 21 - 09 C (0 8 /1 8 ) MultCty -- Firearms Affidavit IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH Family Law Department , Petitioner vs . Respondent ) ) ) ) ) ) ) ) ) ) Case No.: FIREARMS AFFIDAVIT I am (your name), the Respondent in this Family Abuse Prevention Act case. Being sworn, I state that: 1. Surrender of Firearms/Ammunition to Law Enforcement I have surrendered my firearms and ammunition to the law enforcement agency named on the attached receipt. Attach copy of the receipt. 2. Third Party Possession of Firearms and Ammunition The Third Party named on page 2 has taken possession of my firearms and ammunition. A. A gun dealer has conducted a background check on this Third Party and the Oregon State Police have approved the transfer. Third Party must sign affidavit on Page 2 and include the background check number from the Oregon State Police. (or) B. This Third Party does not need a background check because this Third Party is my: [ ] spouse or domestic partner [ ] adult child or adult stepchild [ ] sibling [ ] aunt or uncle [ ] first cousin [ ] parent or step - parent [ ] grandparent [ ] adult grandchild [ ] niece or nephew [ ] spouse or domestic partner of any of the people listed above 3. No Firearms or Ammunition I have not surrendered any firearms or ammunition because I do not own any firearms or ammuntion. I do not have any firearms or ammunition in my custody, control, or possession. I do do not have a concealed handgun license. 4. Decline to Answer I decline to choose one of the options listed above because that may tend to incriminate me. Signature of Respondent Print Name Address or Contact Address City, State, Zip Telephone /Contact Telephone # American LegalNet, Inc. www.FormsWorkFlow.com 2 21 - 09 C (0 8 /1 8 ) MultCty -- Firearms Affidavit Subscribed and sworn to before me this day of , 20. Notary Public/Court Clerk/Judge If notary, my commission expires: THIRD PS AFFIDAVIT ABOUT TAKING POSSESSION I am . (Name of Third Party who has received the firearms/ammunition). Being sworn, I state that: prohibiting Respondent from possessing firearms and ammunition. I agree to receive and store the following firearms and/or ammunition for Resondent while s/he is prohibited by the court order from possessing them. (Set out the make, model, caliber, and serial numbers. Attach extra sheets if needed). Firearm Make Model Caliber Serial Number Ammunition: Describe type and amount: Initial each item listed below to show your understanding and agreement: I am not the protected person in this restraining order case. I do not live in the same residence as Respondent. I am not prohibited from owning or possessing firearms under state or federal laws. Unless I am exempt from the background check (see page 1), the Respondent has done a background check on me through a licensed gun dealer to verify that I am not prohibited from owning or possessing firearms. The Oregon State Police Background Check Number for me is: I agree not to return, loan, or otherwise transfer any firearms to Respondent until this restraining order expires or ends by court order. And: that when the order ends, I can return the firearms without a backgrounds check. or B. I am not one . I understand that even when the order ends, I cannot return the firearms without a licensed gun dealer doing a background check on the Respondent. I understand that violation of these terms may result in the filing of federal and/or state criminal charges against me. Signature of Third Party Print Name of Third Party Address (or Contact Address) Street/City/State/Zip Phone or Con tact Phone # Subscribed and sworn to before me by this day of , 20. Notary Public/Court Clerk/Judge If notary, my commission expires: American LegalNet, Inc. www.FormsWorkFlow.com