IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLANIA
CC# : ______________________
OTN: ______________________
ORDER OF RELINQUIS HMENT
AND NOW, this _________ day of _______________, 20___, it is hereby ORDERED, ADJUDGED
and DECREED that the Defendant, having been convicted of a misdemeanor crime of domestic
violence, as defined by 18 USC§ 921(a)(33)(A), shall:
(1) Not possess, use, control, sell, transfer, or manufacture a firearm in the Commonwealth of
Pennsylvania nor obtain a license to possess, use, control, sell, transfer, or manufacture a
firearm in the Commonwealth of Pennsylvania pursuant to 18 Pa. C.S.A. §6105 (c)(9) and
18 USC§ 922(g)(9);
(2) Relinquish any and all firearms under the defendant’s possession or control to an
appropriate law enforcement agency pursuant to 18 Pa.C.S.A. §6105.2(b) or to a licensed
firearm dealer pursuant to 18 Pa.C.S.A. §6105.2(c)
(3) Relinquish any and all firearms within a period not longer than twenty-four (24) hours
following conviction;
(4) Relinquish to the Sheriff any and all firearm licenses issued under §§6101 or 6109 or 23
Pa.C.S.A. §6108.3
(5) Provide a complete and accurate list of all firearms subject to relinquishment below and;
(6) Identify below in what manner the firearms shall be relinquished, i.e., whether to law
enforcement or licensed dealer.
BY THE COURT:
___________________________________
