Superior Court of Washington For __________________________________ _________ Petitioner DOB vs. __________________________________ _________ Respondent DOB 1. Petition for Surrender of Weapon (PT) I am the petitioner in this action. 2. No. The respondent has: (check all that apply) used, displayed, or threatened to use a firearm or other dangerous weapon in a felony. Describe this offense: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 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: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ possession of a firearm or other dangerous weapon which presents a serious and imminent threat to public health or safety, or to the health or safety of any individual. My concern for imminent threat is based on the following: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ PT FOR SURRENDER OF WEAPON (PT) - Page 1 of 2 WPF DV-4.030 (06/2012) - RCW 9.41.800 American LegalNet, Inc. www.FormsWorkFlow.com 3. Information about the firearms or other dangerous weapon(s): What kind of firearm or other dangerous weapon? 4. My relationship with the other party is: spouse or former spouse parent of a common child current or former cohabitant as intimate partner, including current or former registered domestic partner 5. Where is it located? current or former dating relationship stepparent or stepchild current or former cohabitant as roommate in-law parent or child blood relation other than parent or child I request the court to: Require the respondent to surrender any firearm, other dangerous weapon and any concealed pistol license issued under RCW 9.41.070 Prohibit the respondent 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 respondent because irreparable injury could result if an order is not issued until the time for response has elapsed. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated:_________________________ ___________________________________ Signature of Petitioner Presented by: Petitioner/Petitioner’s Attorney WSBA# Date PT FOR SURRENDER OF WEAPON (PT) - Page 2 of 2 WPF DV-4.030 (06/2012) - RCW 9.41.800 American LegalNet, Inc. www.FormsWorkFlow.com