COURT OF WASHINGTON FOR NO. ___________________________________________ Petitioner PETITION FOR SURRENDER OF WEAPON, NOTICE OF HEARING AND ORDER (HARASSMENT) (PT/ORH) (Clerk's Action Required) vs. ___________________________________________ Respondent 1. I am the 2. The other party has: used, displayed, or threatened to use a firearm or other dangerous weapon in a felony. Describe this offense: ______________________________________________________________________ Petitioner Respondent in this action. . previously committed an offense that makes him or her ineligible to possess a firearm under the provisions of RCW 9.41.040. Describe this offense: . 3. I request the court to: Require the other party to surrender any firearm or other dangerous weapon, or any concealed pistol license issued under RCW 9.41.070 and prohibit the party from obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol license. Order temporary surrender of a firearm or other dangerous weapon without notice to the other party because irreparable injury could result if an order is not issued until the time for response has elapsed. My concern for irreparable injury is based on the following: PT FOR SURR OF WEAPON/NT OF HRG/ORD (HARASSMENT) (PT/ORH) - Page 1 of 2 WPF UH-04.0300 (9/2000) - RCW 9.41.800 2001 © American LegalNet, Inc. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. DATED: Signature of Moving Party ORDER It is ordered that a hearing be held on ___________________________ at ______________a.m./p.m. at ______________________________________________________________ (location) to determine whether the petition for surrender of weapons should be granted. IF YOU DO NOT APPEAR, THE COURT MAY ENTER AN ORDER GRANTING THE REQUESTED RELIEF. Because a showing has been made that irreparable injury could result if an Order is not issued immediately without notice to the other party, IT IS THEREFORE ORDERED THAT: Petitioner Respondent immediately surrender all firearms or other dangerous weapons to: the sheriff of County or police chief of ____________________ that party's counsel other ______________________ to be retained until the hearing scheduled above or until further order of the court. It is further ordered that the clerk of the court shall forward a copy of this order on or before the next judicial day to: ¨ County Sheriff's Office or _____ Police Department where petitioner lives which shall personally serve the petitioner with a copy of this order and shall promptly complete and return to this court proof of service. ¨ County Sheriff's Office or _____ Police Department where respondent lives which shall personally serve the respondent with a copy of this order and shall promptly complete and return to this court proof of service. DATED _____________________________________ JUDGE/COMMISSIONER Presented by: Petitioner Date PT FOR SURR OF WEAPON/NT OF HRG/ORD (HARASSMENT) (PT/ORH) - Page 2 of 2 WPF UH-04.0300 (9/2000) - RCW 9.41.800 2001 © American LegalNet, Inc.