Fill and Sign the Law Enforcement Information Extreme Risk Protection Order

LEI - Extreme Risk PO (LEIS) ( 07/2019 ) [ ] See Reverse For Additional Information  Law Enforcement Information - Extreme Risk Protection Order Do NOT serve or show this sheet to the respondent! Do NOT FILE in the court file. Give this form to law enforcement. Type or print clearly! This completed form is required by law enforcement. This information is necessary to serve, enforce , and enter your order into the state -wide law enforcement computer. Fill in the following information as completely as possible. Court Name: County: Case Number: Respondent’s Information (The person to be restrained from owning, possessing, accessing, or obtaining weapons.) Name: First Middle Last Nickname Relationship to Petitioner Date of Birth [ ] Male [ ] Female Race Height Weight Eye Color Hair Color Skin Tone Build [ ] Current or [ ] Last Known Address Street: City: State: Zip: Phone(s) w/Area Code Need Interpreter? Yes or No Language: Employer Employer's Address WORK Hours: Phone: ( ) Vehicle License Number Vehicle Make and Model Vehicle Color Vehicle Year Drivers License or ID number State Does the restrained person have a disability, brain injury, or impairment requiring special assistance when law enforcement serves the order? [ ] No. [ ] Yes . If yes, describe (continue on back, if needed): Hazard Information - Restrained Person’s History Includes: [ ] Involuntary/Voluntary Commitment [ ] Suicide Attempt or Threats [ ] Threats of “Suicide by Cop” [ ] Assault [ ] Assault with Weapons [ ] Alcohol/Drug Abuse [ ] Other: Weapons: [ ] Handguns [ ] Shotguns [ ] Rifles [ ] Semi -Automatic Assault Rifles [ ] Knives [ ] Explosives [ ] Other: Location of Weapon (s): [ ] Vehicle [ ] On Person [ ] Residence Describe in detail: Has the restrained person had advanced or military firearms training? [ ] No [ ] Yes If yes, describe (continue on separate sheet , if needed): Current Status Are you and the restrained person living together now? Y N (Circle Yes, No) Does the restrained person know you are trying to get this order? Y N Is the restrained person likely to react violently when served? Y N Petitioner’s Information (This is the person, officer, or law enforcement agency that filed the case. They are not protected.) Nam e: First Middle Last Agency Name, if petitioner is a law enforcement officer or agency: Address: (If petitioner is a law enforcement officer, list your agency address.) Phone(s) w/ area code Email address: If your information is confidential , you must provide the name, address, and phone number of someone willing to be your “contact :” If petitioner is represented by an attorney , enter attorney’s name, WSBA #, address, and phone number : Need interpreter? [ ] Yes or [ ] No Language: LEI - Extreme Risk PO (LEIS) ( 07/2019 ) [ ] See Reverse For Additional Information 