Suan or _ Court of Washington, County of OME
Mamew eArpe.—— (e(12[ A) No, _2S-2. [1 30¢-G SOR

Retitioner DOB Protection Order (OR)
[Domestic Violence (PRT)

vs.
VEMOUIICA GOODMGH 2S lige! | ] Sexual Assault (SXP)

Respondent DOB [ ] Harassment (AH)
[ ] Stalking (PSTK)
[ ] Vulnerable Adult (PRTVA)

Clerk’s Action Required: 5.B., 10, 11, 12, 15

 

Protection Order

1. This order is effective immediately and for 1 year from today’s date, unless a
different end date is listed here (end date): UL ul Wis ‘

This protection order complies with the Violence Against Women Act and shall be
enforced throughout the United States. See last page.

2. This order restrains (name): VEMOMIKA f00dNl6 7
also known as (list any known aliases)

The restrained person must obey the restraints ordered in section 8.

 

 

 

 

 

 

Gender Race Height Weight
e Won cAuchs: Atl
Eye Color Hair Color Skin Tone Build
Pow Brew il Ue NOM

 

Noticeable features (Ex.: tattoos, scars, birthmarks):
Has [ ] access to or [ ] possession of [ ] firearms [ ] other weapons [ ] unknown
Surrender weapons ordered: Px] Yes [ ] No

3. This order protects (name):_WATIH WwW (Per DARL

and the following children who are under 18 (if any) [ ] no minors

 

RCW 7.105.310, .315, .325 Protection Order
Mandatory (01/2025) p. 1 of 12
PO 040

 

 

 

 

 

 

 

 

 

Child's Name Age Child's Name Age
1. ELdek Goodihe te Augie 7D Yes ood
. ktpen nooniad-pAudae +4. BH
BS CUA GOD eK RAL |6 &

 

The person who filed this petition requested protection for (check all that apply):

[ ] themself
iPoreaw else. The filing party has the right to petition on the protected person's

behalf because:

[ The filing party is a parent, legal guardian, or custodian of the minor protected

person/s.

[ ] The filing party is age 18 or older and a family or household member of the minor
protected person/s. (For domestic violence orders only.)

[ ] The filing party is age 15 to 17 and filed on behalf of a minor family or household

member. The filing party has been chosen by the minor, and is capable of
pursuing the minor's stated interest in this case.

[ ] The protected person is a vulnerable adult and the filing party is
[ ] the vulnerable adult’s guardian, conservator, or legal fiduciary, or
[ ] an interested person as defined by RCW 7.105.010(19), or

[ ] WA Department of Social and Health Services.

{ ] The protected person is an adult who does not meet the definition of a vulnerable

adult, but who cannot file the petition themselves because of age, disability,
health, or inaccessibility (Do not check this for vulnerable adult or domestic

violence petitions.)

 

 

Warnings to the Restrained Person.

 

 

you to violate the order. You alone are responsible for following the order.

Cie) You can be arrested even if the protected person or persons invite or allow

Only the court may change the order. Requests for changes must be made in

writing.

If you do not obey this order, you can be arrested and charged with a crime.

= The crime may be a misdemeanor, gross misdemeanor, or felony depending

on the circumstances. You may also be found in contempt of court.
= You can go to jail or prison, lose your right to possess a firearm or

ammunition, and/or pay a fine.

= It is a felony to take or hide a child in violation of this order.

= If you travel to another state or to tribal lands or make the protected person
do so, with the intention of disobeying this order, you can be charged with a

federal crime.

 

RCW 7.105.310, .315, 325 Protection Order
p. 2 0f12

Mandatory (01/2025)
PO 040

 

Firearms and Weapons. Even if the court did not issue an Order to Surrender

Cg
(SF) and Prohibit Weapons, under state or federal law you may be prohibited from

getting or having, a firearm, other dangerous weapons, ammunition, or concealed
pistol license for as long as the protection order is in place. 18 U.S.C. § 922(g)(8).
RCW 9.41.800.

 

 

Findings

 

4.

Notice and Hearing

The restrained person had reasonable notice and opportunity to participate. Notice of
this hearing was served on the restrained person by:

[ ] electronic service [personal service [ ] service by mail
[ ] service by publication [ ] other
The restrained person Maid [ ] did not have actual notice of this hearing.
The court held a hearing before issuing this full protection order. These people attended:

[WProtected Person [ Jinperson [ ]byphone [‘{by video
[ ] Protected Person’s Lawyer [ lin person [ ] by phone [ ] by video
[ ] Petitioner (jf not the protected person) [ ]in person [ ]by phone [ ] by video
[W Restrained Person LiHif person [ ] by phone [*] by video
[ ] Restrained Person’s Lawyer [ lin person [ ]by phone [ ] by video
{ ] Other: [ lin person [ ]by phone [ ] by video

{ ] This hearing was held remotely (online or by phone). The court confirmed staff
received no contact from any absent party before proceeding without them.

Basis and Type of Protection Order
The restrained person and protected person/s are (check all that apply):
Intimate Partners
[current or former spouses or domestic partners
[ parents of a child-in-common (unless child was conceived through sexual assault)
[ ] current or former dating relationship (age 13 or older) who
[ ] never lived together [ ] live or have lived together
Family or Household Members.
[ ] parent and child [ ] stepparent and stepchild
[ ] grandparent and grandchild [ } parent's intimate partner and child
{ ] current or former cohabitants as roommates
{ ] person who is or has been a legal guardian
[ ] related by blood or marriage (specify how)
Other (examples: coworkers, neighbors, acquaintances, strangers)

 

 

RCW 7.105.310, .315, .325 Protection Order
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PO 040

 

Based upon the petition, testimony, case record, and response, if any, the court finds by a
preponderance of evidence that the protected person (or petitioner on their behalf) has
proved the required criteria for the following protection order under chapter 7.105 RCW.

Check only one!

oonccte Violence Protection Order- The restrained person has subjected the
protected person to domestic violence: physical harm, bodily injury, assault, or the
infliction of fear of physical harm, bodily injury, or assault; nonconsensual sexual
conduct or nonconsensual sexual penetration; coercive control; unlawful
harassment; or stalking. (For intimate partners or family or household members
only).

[ ] Sexual Assault Protection Order— The restrained person has subjected the
protected person to nonconsensual sexual conduct or nonconsensual sexual
penetration.

[ ] Stalking Protection Order- The restrained person has subjected the protected
person to stalking.

[ ] Vulnerable Adult Protection Order— The restrained person has subjected the
protected person to acts of abandonment, abuse, financial exploitation, or neglect.
The protected person is a vulnerable adult as defined in chapter 7.105 RCW
because the protected person:

[ ] Is over 60 years old and does not have the functional, mental, or physical ability
to care for himself or herself.

[ ] Is an individual subject to guardianship under RCW 11.130.265 or an individual
subject to conservatorship under RCW 11.130.360.

[ ] Has a developmental disability as defined in RCW 71A.10.020.

[ ] Self-directs their own care and receives services from a personal aide under
RCW 74.39.

[ ] Is receiving services from a home health, hospice, or home care agency licensed
or required to be licensed under RCW 70.127.

[ ] Is receiving in-home services from an individual provider under contract with
DSHS.

[ ] Has been admitted to an assisted living facility, nursing home, adult family home,
soldiers’ home, residential habilitation center, or any other facility licensed by
DSHS.

[ ] Vulnerable Adult Objects. The petition was filed by someone other than the
vulnerable adult and the vulnerable adult objects to some or all of the order. The
court finds by clear, cogent, and convincing evidence the petitioner established
that there is abandonment, abuse, financial exploitation, or neglect of a
vulnerable adult and the vulnerable adult is unable, due to incapacity, undue
influence, or duress, to protect their person or estate in connection with the
issues raised in the petition or order based on the following evidence:

 

 

 

 

RCW 7.

105.310, .315, .325 Protection Order

Mandatory (01/2025) p. 4 of 12

PO 040

[ ] Antiharassment Protection Order— The restrained person has subjected the
protected person to unlawful harassment.

[ ] No fee required (stalking, hate crime, single act of violence, or threat of violence
including malicious and intentional threat or presence of firearm/weapon causing
substantial emotional distress, family or household member engaged in domestic
violence, or nonconsensual sexual conduct or penetration or a sex offense.
RCW 7.105.105(9).)

6. Jurisdiction
The court has jurisdiction over the parties and the subject matter.

[\WMinors: Washington state [has exclusive continuing jurisdiction; [ ] is the home
state; [ ] has temporary emergency jurisdiction over the children.

[ ] Temporary Emergency Jurisdiction: The petitioner has until (date)
to return to (state/court with jurisdiction over the minors)
to seek any court orders about these minors:

 

 

The Washington order will terminate on that date for the minors. RCW 26.27.231.

[ ] The person who filed is not a parent of one or more children listed above.
(Important! Complete Protection Order Attachment A: Non-Parent (ICWA),
PO 030A/PO 040A.)

7. Other Findings

[ ] Credible Threat: The restrained person represents a credible threat to the physical
safety of the protected person/s.

[ ] The restrained person is under 18 years of age. The court:

[ ] appointed (name) as guardian ad litem to
represent the restrained person in this proceeding.

[ ] did not appoint someone to represent the restrained person because:

 

[ ] Other:

 

 

 

Restraints (Check ail that apply):

 

 

8. The court orders: To the Restrained Person:
General Restraints

A. [LU-No Harm: Do not cause any physical harm, bodily injury, assault, nonconsensual
sexual conduct or nonconsensual sexual penetration, and do not harass, threaten, or
stalk

[ Me protected person ruahe mire named in section 3 above
[ ] these minors only:

 

 

 

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B. [W No Contact: Do not attempt or have any contact, including nonphysical contact,
directly, indirectly, or through third parties, regardless of whether those third parties
know of the order, except for service of court documents with

tthe protected person [ ] the minors named in section 3 above
[ ] these minors only:

[ ] these members id protected person’s household:

 

 

Pespovideut

1 Exception (if any): Only this type of ntact is allowed: i FP
Wwniclyideo entaetw (th Uulden.
Tah st allow thuldven & vasthey - covwnun-

7. £
Exceptions about minors only, if any, provided in P below. cake felep ov

: . ; ag once

C. [\VStalking Behavior: Do not harass, follow, monitor, Keep under physical or electronic aaa .
surveillance, cyber harass (as defined in RCW 9A.90.120), or use phone, video,
audio, or other electronic means to record, photograph, or track locations or
communication, including digital, wire, or electronic communication, of:

[ ihe protected person [the minors named in section 3 above
[ ] these minors only:

 

 

[ ] these members of the protected person's household:

 

 

D. [M Exclude and Stay Away: Do not enter, return to, knowingly come within, or
knowingly remain within 1,000 feet or other distance (specify) of:
[ fie protected person [ WProtected person’s vehicle
[ ] protected person’s school [ 4protected person's workplace
[ ] protected person's residence [ ] protected person’s adult day program

[ ] the shared residence

[ Ythe residence, daycare, or school of | [1}the minors named in section 3 above
[ ] these minors only:
[ ] other:

 

 

 

Exceptions about minors, if any, provided in P below.
Address: The protected person chooses to (check one)
[ ] keep their address confidential [ ] list their address here:

 

E. [ ] Vacate shared residence: The protected person has exclusive right to the
residence that the protected person and restrained person share (as listed in the Law
Enforcement and Confidential Information form, PO 003). The restrained person
must immediately vacate the residence.

 

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F. [ ] Intimate Images: Do not possess or distribute intimate images of a protected person,
as defined in RCW 9A.86.010. The restrained person must take down and delete all
intimate images and recordings of a protected person in the restrained person's
possession or control and cease any and all disclosure of those intimate images.

G. [

Electronic Monitoring: You must submit to electronic monitoring. (Restrained
person must be age 18 or older.)

Monitoring by (specify):

 

Term (if different from expiration of order):
[ ] Restrained Person must pay cost of electronic monitoring.
H. [

Evaluation: The restrained person shall get an evaluation for: [ ] mental health
[ ] chemical dependency (drugs and alcohol) at:

 

The evaluation shall answer the following question/s:

 

An evaluation is necessary because:

 

 

I. [ ] Treatment: The restrained person shall participate in state-certified treatment as
follows:

[ ] domestic violence perpetrator treatment program approved under
RCW 43.20A.735 at

[ ] sex offender treatment program approved under RCW 18.155.070 at:

 

 

[ ] other:

J. [ ] Personal Belongings: The protected person shall have possession of essential
personal belongings, including the following:

 

 

 

K. [ ] Transfer of Assets: Do not transfer jointly owned assets.
[ ] Finances: The following financial relief is ordered:

 

L. [ ] Vehicle: The protected person shall have use of the following vehicle:
Year, Make & Model License No.

M. [\/Restrict Abusive Litigation: Comply with the Order on Motion to Restrict Abusive
Litigation (FL All Family 155), filed separately.

N. [ ] Pay Fees and Costs: The protected person is granted judgment against the
restrained person as provided in the Judgment (PO 044), filed separately. The court
finds that the restrained person is not under active duty in military or SCRA has been
complied with. 50 U.S.C. § 3931.

 

RCW 7.105.310, .315, .325 Protection Order
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Firearms and Other Dangerous Weapons
we ‘Surrender Weapons: Important! Also use form Order to Surrender and Prohibit Weapons,

 

 

WS 001.
“vd

Findings. The Court (check all that apply):
a the Order to Surrender and Prohibit Weapons because:

the court ordered the No Harm restraints above (section 8.A.) and the court
finds that the restrained person had actual notice and an opportunity to
participate. AND:

«the restrained person represents a credible threat to the physical safety
of a protected person, OR

= this order explicitly prohibits the use, attempted use, or threatened use of
physical force against any protected person.

Therefore, weapons restrictions are required by state law. RCW 9.41.800(2).

[ ] the court finds by a preponderance of the evidence that the restrained
person:

[ ] has used, displayed, or threatened to use a firearm or other dangerous
weapon in a felony; or

[ ] is ineligible to possess a firearm under RCW 9.41.040.

[ ] may issue the orders referred to above because the court finds by a
preponderance of the evidence that the restrained person presents a serious and
imminent threat to public health or safety, or the health or safety of any individual
by possessing a firearm or other dangerous weapon.

The Restrained Person must:

* Immediately surrender to law enforcement and not access, possess, have in their
custody or control, purchase, receive, or attempt to purchase or receive firearms,
other dangerous weapons, or concealed pistol licenses; and

* Comply with the Order to Surrender and Prohibit Weapons filed separately.
Minors
Other family law court cases may modify this order about custody and visitation.

ustody: (/f the parties have children together) The protected person is granted
Prone care, custody, and control of:
t

[ fe minors named in section 3 above
{[ ] these minors only:

 
  
 

 

Exceptions for Visitation and Transportation, if any (including exchanges, meeting
location, and pickup and dropoff):

 

 

Visitation listed here is an exception only to No Contact and Stay Away provisions
about the children in B and D above.

 

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To comply with the Child Relocation Act, anyone with majority or substantially equal
residential time (at least 45 percent) who wants to move with the child must notify
every other person who has court-ordered time with the child. Specific exemptions
from notification may be available if the court finds unreasonable risk to health or
safety. Persons entitled to time with the child under a court order may object to the
proposed relocation. See RCW 26.09.405 - .560 for more information.

Q. [ ] Interference: Do not interfere with the protected person's physical or legal custody of:
[ ] the minors named in section 3 above
[ ] these minors only:

 

R. [ ] Removal from State: Do not remove from the state:
[ ] the minors named in section 3 above
[ ] these minors only:

 

S. [ ] School Enrollment: Do not enroll or continue attending the elementary, middle, or
high school that a protected person attends: (name of school)

 

(Only if both the restrained person and a protected person are students at the same
school. Can apply to students 18 or older. Includes public and private schools.
Complete form PO 040B Attachment B School Transfer.)

 

Pets

a

Custody: The protected person shall have exclusive custody and control of the
following pet/s owned, possessed, leased, kept, or held by the protected person,
restrained person, or a minor child who lives with either the protected or restrained
person. (Specify name of pet and type of animal.):

 

U. [ ] Interference: Do not interfere with the protected person’s efforts to get the pet/s
named above.

V. [ ] Stay Away: Do not knowingly come within, or knowingly remain within
(distance) of the following locations where the
pet/s are regularly found:

[ ] Protected person's residence (home address may be kept confidential)
[ ] Other (specify):

 

 

Vulnerable Adult

W. [ ] Safety: Do not commit or threaten to commit acts of abandonment, neglect, financial
exploitation, or abuse, including sexual abuse, mental abuse, physical abuse,
personal exploitation, and improper use of restraints, against the vulnerable adult.

X. [ ] Accounting: You must provide an accounting of the disposition of the vulnerable
adult's income or other resources by (date)

Y. [ ] Property Transfer: Do not transfer the property of: [ ] the vulnerable adult [ ] the
restrained person. This restraint is valid until (specify date, not to exceed 90 days)

 

 

RCW 7.105.310, .315, .325 Protection Order
Mandatory (01/2025) p. 9 of 12
PO 040

 

Other

2 PeoTecTEy POTY UST ALE Kk UDIFicATION JRO

DL Te FAW LAW WuET SD CONSID. THs oul”
(S WARING NO AMDIMES Re Pree Me 3F Tee
POs. towevne, The Aer ANONS 4 sntraue te iu THe
Tey WOTES ALE ADPEMeY (DCm. THe fous

CUT SE TE we
Other Orders (Check all that apply): Bu LiTEKS

9. [ ] Law enforcement must help the protected person with (RCW 7.105.320(1)):
[ ] Possession of the protected person's residence.

 

 

 

 

[ ] Possession of the vehicle listed in section L above.
[ ] Possession of the protected person's essential personal belongings located at:
[ ] the shared residence
[ ] the restrained person’s residence
[ ] other location:
{ ] Custody of [ ] the minors named in section 3 above

 

[ ] these minors only:
{ ] Other:

[ ] Law enforcement must be present while the restrained person collects personal
clothing, personal items needed during the duration of this order, and these other items
(specify)
from the shared residence that restrained person has been ordered to vacate in D or E
above (RCW 7.105.320(3)).

10. Washington Crime Information Center (WACIC) and Other Data Entry

Clerk’s Action. The court clerk shall forward a copy of this order immediately to the
following law enforcement agency (county or city)

(check only one): [ ] Sheriff's Office or [ ] Police Department

(List the same agency that entered the temporary order, if any)

This agency shall enter this order into WACIC and National Crime Info. Center (NCIC).

 

 

 

11. Service on the Restrained Person

[ ] Required. The restrained person must be served with a copy of this order and any
order to surrender and prohibit weapons.

[ ] The law enforcement agency where the restrained person lives or can be
served shall serve the restrained person with a copy of this order and shall
promptly complete and return proof of service to this court.

Law enforcement agency: (county or city)
(check only one): [ ] Sheriff's Office or [ ] Police Department

 

RCW 7.105.310, .315, .325 Protection Order
Mandatory (01/2025) p. 10 of 12
PO 040

[ ] The protected person (or person filing on their behalf) shall make private
arrangements for service and have proof of service returned to this court. (This is
not an option if this order requires: weapon surrender, vacating a shared
residence, transfer of child custody, or if the restrained person is incarcerated. In
these circumstances, law enforcement must serve, unless the court allows
alternative service.)

Clerk’s Action. The court clerk shall forward a copy of this order and any order to
surrender and prohibit weapons on or before the next judicial day to the agency
and/or party checked above. The court clerk shall also provide a copy of these
orders to the protected person upon request.

[ ] Alternative Service Allowed. The court authorizes alternative service by
separate order (specify):

 

[ ] Not required. See section 4 above for appearances.

[ ] The restrained person appeared at the hearing, in person or remotely, and
received notice of the order. No further service is required. (May apply even if the
restrained person left before a final ruling is issued or signed.)

[ ] The restrained person did not appear at the hearing. However, the material
terms of this order have not changed from the Temporary Protection Order that
was served on the restrained person. No further service is required.

12.[ ] Service on Others (Vulnerable Adult or Restrained Person under age 18)

Service on the [ ] vulnerable adult [ ] adult's guardian/conservator [ ] Restrained
Person’s parent/s or legal guardian/s (name/s) is:

[ ] Required.

[ ] The law enforcement agency where the person to be served lives or can be
served, shall serve a copy of this order and shall promptly complete and return
proof of service to this court.

Law enforcement agency: (county or city)
(check only one): [ ] Sheriff's Office or [ ] Police Department

[ ] The protected person or person filing on their behalf shall make private
arrangements for service and have proof of service returned to this court.

Clerk’s Action. The court clerk shall forward a copy of this order on or before the
next judicial day to the agency and/or party checked above.

[ ] Not required. They appeared at the hearing where this order was issued and
received a copy.

13. Prosecutor’s duty to notify protected person of future firearm restoration:
If the restrained person petitions for restoration of firearms, the prosecutor must:

[ ] Notify the protected person of the restoration petition and of the court’s decision.
The protected person requests notification.

[ ] Do not notify the protected person of the restoration petition or the court’s decision.
The protected person opts out of notification.

This order does not affect law enforcement’s obligation to notify under RCW 9.41.340.

 

RCW 7.105.310, .315, 325 Protection Order
Mandatory (01/2025) p. 11 of 12
PO 040

14. Other Orders (if any):

 

 

 

15. Review Hearing
[ ] No review hearing is scheduled.

[ ] The court schedules a review hearing on (date): at (time):

For (purpose):

Ordered. UD
Dated: 25 AP ML Wat CASI fan)om f

Judge/Court Commissioner

 

Court Phone:

 

Print Judge/Court Commissioner Name

Court Address:
| received a copy of this Order or attended the hearing remotely and have actual notice of this

order. It was, explained to me on the record: ,
ne l Cron ke, Loe dy'ahft—

Wa of Respondent Print Name (Aate

 

 

 

 

Signature of Respondent's Lawyer WSBA No. Print Name Date
> AVAKLED Vik Zoo

Signature of Petitioner Print Name Date
Signature of Petitioner's Lawyer WSBA No. Print Name Date

 

Important! Protected Person, law enforcement must notify you before firearms are returned to the Restrained
Person. Keep your contact information up to date with the law enforcement agency. The Proof of Surrender in the
court file should say which agency has the firearms. RCW 9.41.340.

Hope Card: A Hope Card is a small card you can easily carry that has some details of your protection order. It's
one way to show you have a full protection order. You can request one at www.courts.wa.gov/hopecard,

 

 

 

Certificate of Compliance With VAWA. This protection order meets all "full faith and credit" requirements of the
Violence Against Women Act, 18 U.S.C. § 2265 (1994) (VAWA) upon notice to the restrained person. This court
has jurisdiction over the parties and the subject matter; the restrained person has been or will be given notice and a
timely opportunity to be heard as provided by the laws of this jurisdiction. This order is enforceable in all 50 states,
Indian tribal lands, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American
Samoa, the Northern Mariana Islands, and Guam, as if it were an order of that jurisdiction.

 

 

 

RCW 7.105.310, .315, .325 Protection Order
Mandatory (01/2025) p. 12 of 12
PO 040

SUP aM O¢-

_WD (Pa) _ Court of Washington, County of HL

Whores PRA DI

Petitioner

vs.
VALOMIIER OOD Meth
Defendant/Respondent

Nox_US 2 (308.6 SEF
Order to Surrender

and Prohibit Weapons

C Issued Without Notice (ORWPN)

O Temporary/Pre-Trial (ORWPNP)
@Final/Post Conviction (ORWPNP)

O Compliance Review Hearing (ORCRH)

Next Hearing Date/Time:_5-22-25
At: mg County Syperyor Court
Ww- 331

(Clerk's Action Required)

   
  
 
    
    

Order to Surrender and Prohibit Weapons

Restrained Person

This order restrains the defendant/restrained person (name) VERO (EA GOODNLEbtT

(Restrained Person), based on the findings in the order issued on (date), 4/ wz (v5

This order replaces all prior Orders to Surrender and Prohibit Weapons issued under this

case number.
Surrender of Weapons

Restrained Person: You must immediately surrender all firearms and other dangerous

 

weapons in your possession, custody, or control, to this local law enforcement agency:
King County Gerth oF Garnalieny Police Dept.

You must immediately surrender all firearms and other dangerous weapons
subject to this order, including but not limited to the following:

 

 

 

See the attached sheet if there are more to list.

 

RCW 9.41.800
(07/2023)
Ws 001

Order to Surrender and Prohibit Weapons
p. 1 of 5

Other:

 

 

 

 

 

 

3. Surrender of Concealed Pistol License

Restrained Person: You must immediately surrender any concealed pistol licenses
issued under RCW 9.41.070 to this local law enforcement agency:

 

4. Weapons Prohibition

Restrained Person: You are prohibited from accessing, having in your custody or control,
obtaining, possessing, purchasing, receiving or attempting to purchase or receive any
firearms or other dangerous weapons, or obtaining or possessing a concealed pistol
license.

5. This Order expires:
at the same time as the protection order entered under this case number.
0 on (date) or until further order of the court.
6. Instructions to Restrained Person
If you have firearms, other dangerous weapons, or concealed pistol licenses:

Step 1: Immediately surrender all firearms, other dangerous weapons, and concealed
pistol licenses.

 

Important! If you have notice of this order, immediately surrender all firearms, other dangerous
weapons, and concealed pistol licenses to the local law enforcement agency listed in section 2 on the
same day as the hearing. Contact the local law enforcement agency for directions on how to
immediately surrender the firearms, dangerous weapons, and concealed pistol licenses.

if a law enforcement officer serves you, surrender firearms and other dangerous weapons, and your
concealed pistot license to the law enforcement officer.

 

 

 

Step 2: Get a receipt for the surrender of firearms, other dangerous weapons, and
concealed pistol licenses from law enforcement.

Step 3: Complete the Proof of Surrender form and file it with the receipt, or file other
evidence to prove full and timely compliance.

Step 4: File your documentation from Step 3 with the court clerk by the deadline for this
type of case:

= Civil: within 24 hours.
= Criminal (defendant in custody): before you are released from custody.
= Criminal (defendant not in custody): by the end of your sentencing hearing.

 

RCW 9.41.800 Order to Surrender and Prohibit Weapons
(07/2023) p.20f5
WS 001

If you do NOT have firearms, other dangerous weapons, or concealed pistol
licenses:

Step 1: Immediately complete and sign the Declaration: No Weapons to Surrender form
or gather other evidence that proves full and timely compliance.

Step 2: File your documentation from Step 1 with the court clerk by the deadline for this
type of case:

= — Civil: within 24 hours.
= Criminal (defendant in custody): before you are released from custody.
= Criminal (defendant not in custody): by the end of your sentencing hearing.

If you already surrendered all firearms, other dangerous weapons, and concealed pistol licenses
under another order, they must remain in the possession of the law enforcement agency that
received them until further order of the court. You must provide proof of previous surrender to
the court in this case.

The Law Enforcement Officer serving this order shall inform you that the order is in effect upon
service and that you must immediately surrender all firearms, other dangerous weapons, and
any concealed pistol licenses issued under RCW 9.41.070. The serving officer shall conduct a
search for firearms, other dangerous weapons, and concealed pistol licenses as permitted by
law. The serving officer shall take possession of:

= All firearms,

«Other dangerous weapons,

* Concealed pistol licenses belonging to Restrained Person,
that are surrendered, in plain sight, or discovered during a lawful search. RCW 9.41.801.
7. 0 Criminal Case: Law Enforcement To Accompany Defendant for Surrender.

The court finds that surrender of all firearms, dangerous weapons, and any concealed
pistol license was not possible before release from custody or conclusion of the
sentencing hearing.

The court orders (law enforcement agency) to

accompany defendant to (location)
. Law

 

enforcement must file the Receipt within 24 hours.
8. Washington Crime Information Center (WACIC) and Other Data Entry

Clerk’s Action. The court clerk shall forward a copy of this order immediately to the
following law enforcement agency (county or city)

(check only one): (1 Sheriff's Office or 01 Police Department

(List the same agency that entered the temporary order, if any)

This agency shall enter this order into WACIC, NCIC, and NICS.
9. Service

O Required. The law enforcement agency where the defendant/restrained person
lives or can be served shall prioritize serving the restrained person with a copy of this
order and shall promptly complete and return proof of service to this court.

 

RCW 9,41.800 Order to Surrender and Prohibit Weapons
(07/2023) p.30f5
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Law enforcement agency: (county or city)
(check only one): O Sheriff's Office or 0 Police Department

Clerk’s Action. The court clerk shall forward a copy of this order on or before the
next judicial day to the agency and/or party checked above.

Not Required. The restrained person appeared at the hearing, in person or
remotely, and received notice of the order. No further service is required. (May apply
even if the restrained person left before a final ruling is issued or signed.)

 

 

10. Compliance Hearing
To decide if a compliance hearing is needed, the’court considered:
0 restrained person’s attestation
01 law enforcement verification
1 police report and documentation of firearms or their recovery
O Department of Licensing firearm records
O ~Washington State Patrol firearm records
O protection order narrative, sections about firearms and dangerous weapons, and
attachments
0 affidavits by law enforcement, protected person, or petitioner in response to
restrained person's declaration about firearms surrender
O other:
11. The court orders (check one):

O Respondent: You must attend the hearing listed on page 1 of this order and
show the court that you surrendered your firearm/s and concealed pistol license/s.

C Respondent’s compliance found: No hearing required. The court finds a
sufficient showing that respondent has timely and completely surrendered all
firearms and dangerous weapons in the respondent's custody, control, or possession
and any concealed pistol license to a law enforcement agency and is in compliance
with this order. The compliance hearing is waived per RCW 9.41.801(6).

12. Warnings!

«If you fail to comply with this order, you may be found in contempt of court and/or be
charged with a misdemeanor and punished accordingly.

e You may also be charged with a crime up to and including a felony if you are found
to own, possess, or control a firearm or other dangerous weapon.

e You have the right to remain silent and not make statements that may incriminate
you. Anything you say can be used against you in a court of law. You have the right
to consult with a lawyer before responding to this Order.

e This order may be extended pursuant to RCW 10.99.040(3).

13. Protection against self-incrimination

Voluntarily surrendering weapons may not be used against a Restrained Person in

any criminal prosecution under chapter 7.105, 9.41, or 94.56.310 RCW, or in any

criminal prosecution pursuant to which this Order to Surrender and Prohibit Weapons
RCW 9.41.800 Order to Surrender and Prohibit Weapons
(07/2023) p.4 of 5

WS 001

was issued, except a prosecution for perjury, giving false statement, or otherwise failing
to comply with the order.

Ordered.
Dated A [2 (26 at (time) ASE ‘a.m/p.m.

| received a copy of this order.

— [eserves Le achn bs bf

Say Restrained Person/Defendant Print Name C

  

Judge/Commissioner

 

Signature of Restrained Person/Defendant's Attorney WSBA No. Print Name

Pppeamed vin Foor

Signature of Protected Person or Attorney WSBA No. Print Name

You may download the forms listed in this order from the Washington Courts’ forms website:
http://www.courts.wa.gov/forms/.

 

 

RCW 9.41.800 Order to Surrender and Prohibit Weapons
(07/2023) p.50f5
WS 001

