Mendocino — MFD-022

Source: https://www.mendocino.courts.ca.gov/system/files/mfd-022.pdf

SUPERIOR COURT OF CALIFORNIA COUNTY OF MENDOCINO

a Ukiah Main Courthouse a Ten Mile Branch 100 North State Street 700 South Franklin Street Ukiah, CA 95482 Fort Bragg, CA 95437 Restrained Party (name and address)

Case No.:

NO UNREGISTERED OR REGISTERED GUNS OR OTHER FIREARMS STATEMENT Hearing date:

Hearing time:

Courtroom:

a I don’t own or have in my possession a gun, firearm, or ammunition.

My firearm(s) was:

a Seized by Law Enforcement
a Stolen
a Sold
a Destroyed
a Lost
a Other: ___________________________________________________________

I declared under penalty of perjury under the laws of the State of California that the
forgoing is true and correct.

Dated:

_____________________________________
Signature of Restrained Person/Defendant

If applicable, return form five (5) days prior to court hearing.

MFD-022-local (rev 1210 FC 638.9
PC 136.2
CCP 527.9