Form 4-1015. Extreme risk firearm protection order firearm relinquishment receipt form.

[Extreme Risk Firearm Protection Order Act, NMSA 1978, Sections 40-17-1 to -13] STATE OF NEW MEXICO COUNTY OF __________________ __________________ JUDICIAL DISTRICT IN THE MATTER OF AN EXTREME RISK FIREARM PROTECTION ORDER FOR _______________________________ (Respondent) _______________________________ (Respondent’s full date of birth) No. _________________________ EXTREME RISK FIREARM PROTECTION ORDER (ERFPO) FIREARM RELINQUISHMENT RECEIPT FORM 1. Respondent’s Information – Person Subject to an Extreme Risk Firearm Protection Order (ERFPO) Name: ________________________________________________________________ Mailing Address: ________________________________________________________ City: _______________________________ State: ___________ Zip: _____________ Email:_________________________________________________________________ RESPONDENT: The Court has ordered you to immediately relinquish all firearms in your possession, custody, or control. You must deliver your unloaded firearms to either a law enforcement officer, who will complete section 2, or to a federal firearms licensee, who will complete section 3. You must immediately file this completed form with the Court to prove that you have obeyed the Court’s order. LAW ENFORCEMENT: The Court has ordered Respondent in the above listed ERFPO to immediately relinquish all firearms in their possession, custody, or control. If firearms have been relinquished to law enforcement, complete sections 2 and 4 of this form. Once completed, you must immediately file this form with the Court to confirm the respondent’s compliance with the Court’s order. 2. To Be Completed by Law Enforcement  make sure to sign on page 2 3. To Be Completed by Firearms Dealer  make sure to sign on page 2 Fill out sections 2 and 4 of this form. You must immediately file this form with the Court to confirm the respondent’s compliance with the Court’s relinquishment order. The firearm(s) listed in section 4 were turned in on: __________________ at __________ □ am □ pm date time Name of Law Enforcement Agency: _______________________________________ Please Print Fill out sections 3 and 4 of this form. Keep a copy of this form and give the original to the person who turned in the firearm(s). The firearm(s) listed in section 4 were: □ sold to me □ transferred to me for storage on: _________________ at _________ □ am □ pm date time To:____________________________________ Name of Federal Firearms Licensee (FFL) – Please Print Licensee number: ________________________ 4. List of Firearms MAKE MODEL SERIAL NUMBER Initials - Person Accepting Firearms 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. □ Check this box if more than ten (10) firearms were turned in, sold, or stored. Attach another sheet to this form that lists the make, model, serial number and the initials of the person accepting firearms. I declare under penalty of perjury under the laws of the State of New Mexico that I took possession of a total of ______________ (number) firearm(s) belonging to the respondent subject to the ERFPO. ____________________________________ Name – Please Print _______________________________________ Signature of Law Enforcement or FFL Location where respondent may later retrieve firearms upon the expiration or termination of the ERFPO: Street address: _________________________________________________________ City: ____________________________ State: _____________ Zip: _______________