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STATE OF NEW MEXICOCOUNTY OF ____________________________________________________JUDICIAL DISTRICT COURTCase Number: D - _________ - DV – 20 _______ - ___________________RESTRAINED PARTY’S STATEMENT OF FIREARM POSSESSIONPlease provide the following information:1. I, __________________________________________________________, am the respondent in the above captioned case.2. Within the last thirty (30) days I have owned, possessed, cared for, or had custody or control over any firearm(s)? □ NO. If you answered no, please continue to signature line. □ YES. If you answered yes, please continue to question 3.3. Within the last thirty (30) days I have sold, transferred, pawned, disposed or otherwise removed a firearm from my home?□ NO.□ YES. Please describe what you did with the firearms: ______________________________ ____________________________________________________________________________________________________________________________________________________________________4. I currently own, possess, care for and/or have custody or control over the following firearms:_______ long guns (includes rifles and shot guns) Number Total Number of Firearms ___________________ handguns (includes revolvers and pistols) Number______ Other: ________________________________________________________________ NumberI swear or affirm that the information I have provided in this document is correct and true, to the best of my knowledge.? ______________________________ Respondent’s Signature Date ................
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