This form contains 53 fields organized into 16 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Case Number
Case Number Text
Enter the case number.
Court Filing Information
Court Case Number Text
Provide the unique identifying number assigned to the court case.
Date Received by Court Date
Provide the date when the form was received by the court.
Firearms Possession Question
Firearms Possession No Checkbox
Check this box if the person does not have any firearms, firearm parts, ammunition, or body armor.
Firearms Possession I Don't Know Checkbox
Check this box if you do not know whether the person has any firearms, firearm parts, ammunition, or body armor.
Firearms Possession Yes Checkbox
Check this box if the person has any firearms, firearm parts, ammunition, or body armor, and provide details below.
Firearms Information Text
Provide any known information about the type, amount, or location of firearms, firearm parts, ammunition, or body armor possessed by the person.
First Protected Person
First Protected Person's Name Text
Enter the full name of the first person you want protected.
First Protected Person's Gender Text
Enter the gender of the first person you want protected.
First Protected Person's Race Text
Enter the race of the first person you want protected.
First Protected Person's Date of Birth Date
Enter the date of birth of the first person you want protected.
Fourth Protected Person
Fourth Protected Person Name Text
Enter the full name of the fourth person you want protected.
Fourth Protected Person Gender Text
Enter the gender of the fourth person you want protected.
Fourth Protected Person Race Text
Enter the race or ethnicity of the fourth person you want protected.
Fourth Protected Person Date of Birth Date
Enter the birth date of the fourth person you want protected.
General
Print Button
Save Button
Clear Button
Language Proficiency Question
Yes CheckBox
I don’t know CheckBox
No (list language) CheckBox
Language Text
Enter the language spoken by the person if not English.
More People to List
More People to List Checkbox
Check this box if you have more people to list beyond the provided spaces and will attach a separate piece of paper.
Second Protected Person
Second Protected Person's Name Text
Enter the full name of the second protected person.
Second Protected Person's Gender Text
Enter the gender of the second protected person.
Second Protected Person's Race Text
Enter the race of the second protected person.
Second Protected Person's Date of Birth Date
Enter the date of birth of the second protected person.
Subject's Contact and Employment
Employer Name and Address Text
Provide the name and full address of the subject's employer.
Telephone Number Text
Enter the subject's telephone number.
Subject's Government ID
SSN Text
Enter the subject's Social Security Number.
Driver's License Number and State Text
Enter the subject's driver's license number and the state that issued it.
Subject's Personal Information
Subject's Name Text
Enter the full legal name of the subject.
Subject's Other Names Used Text
Enter any other names, including aliases or previous names, that the subject has used.
Subject's Marks, Scars, or Tattoos Text
Provide a detailed description of any identifying marks, scars, or tattoos on the subject.
Third Protected Person
Third Protected Person Name Text
Provide the full name of the third protected person.
Third Protected Person Gender Text
Enter the gender of the third protected person.
Third Protected Person Race Text
Enter the race of the third protected person.
Third Protected Person Date of Birth Date
Provide the date of birth for the third protected person.
Vehicle Information
Vehicle Type Text
Enter the type of the vehicle, such as 'sedan', 'SUV', or 'truck'.
Vehicle Model Text
Enter the specific model of the vehicle.
Vehicle Year Text
Enter the manufacturing year of the vehicle.
Plate Number Text
Enter the vehicle's license plate number.
Your Information
Your Information Age Text
Provide your current age in years.
Your Information Date of Birth Date
Enter your full date of birth, including the month, day, and year.
Your Information Telephone Text
Enter your telephone number.
Speaks English No Checkbox
Check this box if you do not speak English.
Speaks English Yes Checkbox
Check this box if you speak English.
Your Information Other Language Text
If you do not speak English, list the language you speak.
Gender X (nonbinary) Checkbox
Check this box if your gender is nonbinary.
Gender M Checkbox
Check this box if your gender is male.
Gender F Checkbox
Check this box if your gender is female.
Your Information Race Text
Enter your race.
Your Name
Your Name Text
Provide your full name.