Fill and Sign the Order Without Notice Form

Temporary Extreme Risk Protection Order - Page 1 of 3 Without Notice (EXRPO) XR 121 ( 07/2019 ) RCW 7.94.060, .120 Court of Washington For County No . Petitioner vs. Respondent DOB Temporary Extreme Risk Protection Order - Without Notice (EXRPO) Next Hearing Date/Time: ____________ Court address: At : Clerk's Action Required page 3 Warning to Respondent! You are prohibited from having a firearm in your custody or control, or from purchasing, possessing , accessing, or receiving any firearm. You must surrender any and all firearms including but not limited to the firearms as described below . If you violate this order, you may be charged with a crime and you may not be able to have a firearm for at least five more years after this order expires. RCW 7.94.120. You have the sole responsibility to avoid or refrain from violating this order. Only the court may change this order and only after written application. Respondent’s Distinguishing Features: Respondent I dentifiers ____________________________________ _____________________________________ _____________________________________ _____________________________________ Sex/Gender Race Hair Height Weight Eyes This temporary order expires at the end of the next hearing date listed above. Respondent: You must immediately surrender all firearms and any concealed pistol license s listed below. If you have other firearms, you must surrender all of them also: Attach additional sheet if there are more firearms to list. Temporary Extreme Risk Protection Order - Page 2 of 3 Without Notice (EXRPO) XR 121 ( 07/2019 ) RCW 7.94.060, .120 Respondent : This order is valid until the date and time noted above. You are required to surrender all firearms in your custody, control, or possession. You may not have in your custody or control, purchase, possess, receive, or attempt to purchase or receive, a firearm while this order is in effect. You must surrender to the _______________________________ (name of local law enforcement agency) all firearms in your custody, control, or pos session and any concealed pistol license s issued to you under RCW 9.41.070 immediately. A hearing will be held on the date and time noted above to determine if an extreme risk protection order should be issued. Failure to appear at the hearing may result in a court making an order against you that is valid for one year. You may seek the advice of an attorney as to any matter connected with this order. Based upon the evidence presented, the court finds reasonable cause to believe the respondent poses a s ignificant danger of causing personal injury to self or others in the near future by having in respondent’s custody or control, purchasing, possessing, accessing, or receiving firearms based upon (check all that apply) : a. [ ] Respondent has access to s omeone else’s firearm(s). b. [ ] Respondent expressed intent to obtain a firearm(s). c. [ ] Respondent has unlawfully or recklessly used, displayed, or brandished a firearm. d. [ ] Respondent recently acquired a firearm(s). e. [ ] Respondent violated a civil or criminal protection order, no -contact order , or restraining order issued under chapter 7.90, 7.92, 10.14, 9A.46, 10.99, 26.50, or 26.52 RCW. f. [ ] Respondent was/is the subject of a previous or current extreme risk protection order. g. [ ] Respondent violated a previous or current extreme risk protection order. h. [ ] Respondent has been arrested for or convicted of a domestic violence crime. i. [ ] Respondent has been arrested for or convicted of a felony offense or violent crime. j. [ ] Respondent has been convicted of a hate crime offense or malicious harassment under RCW 9A.36.080 . k. [ ] Respondent has recently committed or threatened violence against self or others, whether or not respondent had a firearm. l. [ ] Respondent has shown, within the past 12 months, a pattern of acts or threats of violence, which can include violent acts against self or others. m. [ ] Respondent has a history of use, attempted use, or threatened use of physical force against another p erson. n. [ ] Respondent has a history of stalking another person. o. [ ] Respondent has a dangerous mental health issue. p. [ ] There is corroborative evidence of respondent’s abuse of [ ] alcohol or [ ] controlled substances. q. [ ] Other: Temporary Extreme Risk Protection Order - Page 3 of 3 Without Notice (EXRPO) XR 121 ( 07/2019 ) RCW 7.94.060, .120 Federal and Washington State Computer -Based System Data Entry The clerk of court shall forward a copy of this order on the same day the court issues the order to the _____________________ County Sheriff's Office or ________________________ City/Town Polic e Department where respondent lives which shall enter this order into the available federal and state computer -based criminal intelligence information systems per RCW 7.94.110. Service [ ] The clerk of court shall forward a copy of the petition, notice of hearing, and this order on or before the next judicial day to the _____________________ County Sheriff's Office or ________________________ City/Town Police Department where respondent live s who will serve a copy of the petition and this order on respondent and return of service with the court . DOL Notification The issuing court shall within three judicial days after this order is issued, forward a copy of the respondent’s driver’s license or identicard, or comparable information along with the date of issuance to DOL. RESPONDENT: You must appear at the next hearing stated on page one of this order. Dated: _______________ at _________ a.m./p.m. _________________________________ Judge/ Commissioner Presented by: Signature of Petitioner/Attorney WSBA No. Print Name / Badge Number, if applicable The petitioner or petitioner’s attorney must complete the Law Enforcement Information – Extreme Risk Protection Order (LEIS) , form XR 105.