Fill and Sign the Washington Notice Form

Court of Washington For Plaintiff vs. Defendant. No. Notice of Ineligibility to Possess Firearm (NTIPF) To the Above-Named Defendant: You are hereby advised that you have been convicted of one or more of the following crimes committed by one family household member against another. Fourth Degree Assault Coercion Stalking Reckless Endangerment Criminal Trespass in the First Degree Violation of a Protection Order or No-Contact Order You must immediately surrender any firearm or other dangerous weapon and any concealed pistol license . You may not possess, own or have under your control a firearm, and under federal law any firearm or ammunition, other dangerous weapon, or a concealed pistol license until your right has been restored by the court of record that ordered the prohibition on possession of a firearm or the superior court where you live, and by a federal court if required. Violation is a felony. This document has been read to the defendant. Dated: Defendant’s Signature Judge/Commissioner/Pro Tem Defendant’s Last Name First Name Middle Name List any aliases Residential Street Address City State Zip Date of Birth (month/date/year) Driver’s License/ID Number Race ____________ Sex _________ Weight __________ Height ________ Eyes _________ Hair _________ Court NCIC # ___________________________________ Submit to: Dept. of Licensing, Business & Professions Firearms Unit, PO Box 9649, Olympia, WA 98507-9649. Notice of Ineligibility to Possess Firearm (NTIPF) - Page 1 of 1 CrRLJ 07.0800 - (02/2016) RCW 9.41.040, .800