CV-434, 02/17 Order to Sheriff for Firearms Record Check/Response of Sheriff 247813.1285(7), Wis. Stats., 18USC 247921.922 This form shall not be modified. It may be supplemented with additional material. S TATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE POSSESSION OF FIREAR MS BY Name of person subject to firearm restriction Date of Birth Amended Order to Sheriff for Firearms Record Check/ Response of Sheriff Case No. The above-named person has petitioned the court to return firearms which were ordered surrendered in an injunction dated . A copy of the Petition is attached. THE COURT ORDERS: The sheriff of this county complete the bottom portion of this order within 5 business days of receipt indicating whether or not this person has been convicted of a felony in a state or federal court; has been convicted of a misdemeanor crime of domestic violence; is prohibited by an order of any federal or state court from possessing a firearm, other than the order in this case; OR is for any other reason known to the sheriff to be prohibited from possession of a firearm. RESPONSE OF SHERIFF As ordered, I conducted the following records check An NCIC records check, as of [Date] . A CIB records check, as of [Date] . A firearms restriction records check, as of [Date] . This records check indicated that this person has not has been convicted of a felony in a state or federal court. has not has been convicted of a misdemeanor crime of domestic violence. is not is prohibited by an order of a federal or state court from possessing a firearm other than the order in this case. is not is prohibited from possession of a firearm for other reasons known to me. (Attach further information for any affirmative answer.) DISTRIBUTION : 1. Court 2. Sheriff Signature Title Date American LegalNet, Inc. www.FormsWorkFlow.com