Fill and Sign the Instructions for Petition for an Extreme Risk Protection Order Form

XRi 101 ( 07/2019 ) Page 1 of 4 Petition for an Extreme Risk Protection Order Instructions for Petition for an Extreme Risk Protection Order An Extreme Risk Protection Order is designed to prevent individuals who are at high risk of harming themselves or others from accessing firearms by allowing family, household members, and police to obtain a court order when there is demonstrated evidence that the person poses a significa nt danger, including danger as a result of threatening or violent behavior. This type of order doesn’t provide protections to the petitioner. It cannot order restraints against the respondent such as “do not harm,” “stay away from,” and “do not contact” the petitioner. The court can order that the respondent surrender firearms and any concealed pistol license s, and that respondent not possess or purchase firearms. If the respondent is under 18 years old, use the form “Petition for Extreme Risk Protect ion Order – Respondent Under 18 Years .” This form is used to start the case. This form will be:  Filed as a public court record and will start a civil court case.  Served (personal delivery) to the person against whom you are seeking the order. The information in the petition is used by the court to determine if:  You are authorized to file this type of petition.  The court has authority to enter an order on your behalf.  The respondent’s behavior meets the legal requirements for the court to grant the order. This form is used to request both an immediate temporary order and a full order:  If you have facts to support your fears, and the court finds an emergency exists, t he court may immediately issue a temporary order that will last until the court holds a hearing, usually within 14 days. o The clerk shall forward a copy of the petition and the temporary order to law enforcement who will serve the respondent.  There is no fee. o You must provide an address for the respondent. o The law enforcement officer completing service on the respondent must file an affidavit, declaration, or certificate of service with the court or the hearing cannot go forward.  You must attend the hearing. At the hearing, the court will determine if it should issue a full order. The respondent has a right to attend that hearing and defend against your allegations. XRi 101 ( 07/2019 ) Page 2 of 4 Petition for an Extreme Risk Protection Order Please Print Clearly Using Black or Blue Ink! Top of the form (Page 1) Fill in your name (first, middle initial, last) as the “Petitioner.” The person against whom you DUHILOLQJLVWKH³5HVSRQGHQW´)LOOLQWKHUHVSRQGHQW VQDPHILUVWPLGGOHLQLWLDOODVW Who is Filing this Case (Section 1) The court must know who is filing this case.  If you are a family or household member, check the 1.A box and also check the box identifying your relationship with the respondent.  If you are a police officer or you’re filing on behalf of a law enforcement agency, check the 1.B box and identify the agency. Also check the appropriate box about notice you’ve SURYLGHGRUZLOODWWHPSWWRSURYLGHWRWKHUHVSRQGHQW¶VIDPLO\RUKRXVHKROGPHPEHURU any known third parties who may be at risk. Residency (Section 2) Chec k the applicable box/es. Firearms (Section 3) The court needs to know the type and location of any firearms the respondent currently owns, possesses, has custody of, has access to, or controls. In section 3, check the type of firearm, list the number o f each type, where the firearms are kept, and the date, time, and place you last saw them. You can use the Firearm Identification Worksheet , form XR 102, to help identify types of firearms. You may attach the Firearm Identification Worksheet to your peti tion. On the top of page 2, in section 3, check the boxes that apply and write in the facts that explain the boxes you checked. Court Cases Involving You (Section 4) This may not be the first court proceeding involving you and the respondent. The cou rt will need to know about other cases, such as divorce, parentage, or criminal, or other restraining orders , protection orders , or no -contact orders. If there are other cases or court orders involving you and the respondent, list the case name (the parties' names), the case number (if you know it), the court (district, municipal, or superior) and the county, type of case, name of any protected person, and any times the respondent violat ed the order . Court Cases Involving Others (Section 5) The court must know about any other court cases between the respondent and any other person. To the best of your knowledge, list any criminal or civil lawsuits; protection, restraining, or no -cont act orders. XRi 101 ( 07/2019 ) Page 3 of 4 Petition for an Extreme Risk Protection Order Request for Emergency Order (Section 6) You may fear that , in the near future , the respondent poses a significant danger of causing personal injury to others or to him or herself, through the use of firearms. You can ask the court to rest rict the respondent’s right to firearms on a temporary basis, until the court hearing. Check the box and describe the facts that support your fears. Statement (Section 7, Page 3) First read through the statement section in the petition before you start writing. There are several places for you to provide facts about the respondent’s behavior and describe your reasons for filing this case. Convictions or Arrests (Section 8) The court will consider the respondent’s criminal history involving felonies, domestic violence, hate crime offenses, and violent crimes. If you have knowledge that the respondent has been arrested or convicted of such crimes, check the appropriate box/es and describe. Violence and Threats (Section 9) The court will consider the behavior that causes you to fear the respondent poses a significant danger of causing personal injury to others, or to him or herself. Check each box that applies and descri be exactly what happened. Include details such as dates, locations, statements, and injuries. You may attach additional pages if you need more room to write. Respondent’s Behavior (Section 10) The court will consider any behaviors that present an imm inent threat of harm to self or others . Describe anything the respondent has said or done that causes you to fear such harm. Evidence of Alcohol or Substance Abuse (Section 11) Describe evidence of respondent’s abuse of alcohol, legal or illegal drug s, including driving under the influence of alcohol or drugs. Other (Section 12) If you have additional information to help the court make a decision, describe it here. If you have additional documents such as records , reports, printouts of text messages or other social media, you may attach them to the petition. Alert: Any medical records must be filed under seal XRi 101 ( 07/2019 ) Page 4 of 4 Petition for an Extreme Risk Protection Order Address for You to Receive Legal Documents (Section 13) The respondent has a right to have you served with legal documents in response to this petition or to notify you of hearings. Check the box to indicate where you agree to accept service. Write in the complete physical address.  List your residential address. If disclosure of your residential address wil l put your safety or the safety of your family or household at risk, you are entitled to keep it confidential. You must list an alternate address where you agree to accept legal documents.  If you are filing on behalf of a law enforcement agency, list the agency’s physical address. Sign the Form When you are done completing the petition, you will swear to the truthfulness of your statement. Put today’s date in the date line and fill in the city where you are completing this form. Sign the form. Pri nt your name below your signature. If you are a law enforcement officer, include your badge/personnel number. If you are an attorney, include your Washington State Bar Association number. Law Enforcement Information – Extreme Risk Protection Order (LEIS ) You must complete a Law Enforcement Information – Extreme Risk Protection Order (LEIS), form XR 105. This form is confidential , and it does not go in the public court file and is not served on the respondent.  It is used by Law Enforcement to locate and identify the respondent when serving documents.  It is also used by Law Enforcement when entering the order in the state -wide database. Complete as much information as possible, especially first name, middle initial, last name, and date of birth. If the respondent has a disability, brain injury, or other impairment, you may know of special assistance that law enforcement could provide when serving the documents. For example: “Respondent has a brain injury . If respondent is rushed, respondent may freeze up and may not respond quickly, or may become verbally aggressive. Remind respondent to contact a friend.” “Respondent has epilepsy and diabetes and may have seizures when stressed. Respondent doesn’t re spond well to being rushed and will need time to get meds and supplies.”