Fill and Sign the Waiver of Informed Consent Form B

DV-800/JV-252 Clerk stamps below when form is filed. Proof of Firearms Turned In or Sold 1 Protected person’s name: 2 Your name (restrained person): To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished. Your address (skip this if you have a lawyer): (If you want your address to be private, give a mailing address instead): Court name and street address: City: State: Zip: Your phone # (optional): ( ) Your lawyer (if you have one): (Name, address, phone #, and State Bar #): 3 Superior Court of California, County of To the person selling or turning in firearms: Case Numbers: When you sell or turn in your firearms, ask law enforcement or the gun dealer to complete item ❹ or ❺ and item ❻. After the form is signed, take it to the court clerk. Keep a copy. For help, read Form DV-810. To: Law Enforcement 4 To: Licensed Gun Dealer 5 Fill out parts ❹ and ❻ of this form. Keep a copy and give the original to the person who turned in the firearms. The firearms listed below were turned in on: Date: at: អ a.m. អ p.m. To: Name and title of law enforcement agent Fill out parts ❺ and ❻ of this form. Keep a copy and give the original to the person who sold the firearms to you. The firearms listed below were sold on: Date: at: អ a.m. អ p.m. To: Name of licensed gun dealer License number ( Telephone ) Name of law enforcement agency I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. ➤ ➤ Signature of law enforcement agent 6 Address Signature of licensed gun dealer Firearm Make Model Serial # 1. 2. 3. អ Check here if more firearms. Attach a sheet of paper and write “DV-800, Item 6 — Firearms Turned In or Sold” at the top. Include make, model and serial # for all other firearms. Judicial Council of California, www.courtinfo.ca.gov New January 1, 2003, Optional Form Family Code, § 6389 et seq. Save This Form Proof of Firearms Turned In or Sold Print This Form (Domestic Violence Prevention) Clear This Form DV-800/JV-252, Page 1 of 1 For your protection and privacy, please press the Clear This Form button after you have printed the form.