ORDER TO SURRENDER FIREARMS PURSUANT TO NRS 200.481, NRS 200.485, NRS 202.360, and 18 U.S.C. § 921(a)(33)

Pursuant to the requirements of NRS 200.485, NRS 202.360, and 18 U.S.C. § 921(a)(33), you are hereby notified that you are prohibited from owning, possessing, or having under your custody or control any firearm. You are further notified that violation of this Order is a Category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less than one year and a maximum term of not more than six years and may further be punished by a fine of not more than $5000. Good cause appearing therefore:

IT IS HEREBY ORDERED that you must permanently surrender, sell, or transfer any and all firearms that you own, in your possession, or under your control not later than 24 hours from the date of this Order, in the following manner, as indicated by the corresponding checkmark:

Surrender any firearm(s) in your possession, custody, or control to the Reno or Sparks Police Departments, Washoe County Sheriff’s Office, or another law enforcement agency. The law enforcement agency shall provide you with a receipt which includes a description and serial number of each firearm surrendered; or

2. Surrender any firearm(s) in your possession, custody, or control to the following person:    Name. In this circumstance, you shall provide to this Court and to either the Reno Police Department, Sparks Police Department, Washoe County Sheriff’s Office, or another law enforcement agency the name and address of the person to whom each firearm was surrendered, along with a description and serial number of each firearm surrendered; or

3. Sell or transfer any firearm(s) in your possession, custody, or control to a licensed firearm dealer as defined in 18 U.S.C. § 923(a). The licensed firearm dealer shall provide you with a receipt which includes a description and serial number of each firearm surrendered.

IT IS FURTHER ORDERED that not later than 72 hours or one business day, which-ever is later, after the surrender, sale, or transfer of any such firearm, you shall provide thereceipt and/or documents described in the checked paragraph above to this Court from theperson or entity to whom any such firearm was surrendered, sold, or transferred.

IT IS FURTHER ORDERED that in the event you currently do not own or have any firearm(s) in your possession, custody, or control, you shall execute the subsequent Declaration under penalty of perjury.

IT IS SO ORDERED.

I, Defendant Name, hereby declare to this Court that I do not own, possess, or have under my custody or control, any firearm(s). I further acknowledge that my failure to surrender, sell, or transfer any firearm(s) I own, possess, or have under my custody or control is a violation of this Order and state law.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on:   Date         Defendant's Signature