ORDER TO TRANSFER FIREARMS
__________________________COURT

AND SUSPEND HANDGUN PERMIT

PARISH/CITYOF______________________

____________________________________________

DIVISION:_________DOCKET:___________

DEFENDANT (PRINT NAME)
FILED:________
DATE OF BIRTH:____________ RACE:______SEX:

M

CLERK:_____________

F

THIS MATTER having come before the undersigned Judge, the court renders the following order:
That PURSUANT TO TITLE 35 OF Code of Criminal Procedure Arts 1000 through 1003, LA R.S.
14:95.10 AND OR LA R.S 46:2136.3, and Federal Law 18 U.S.C. 922(g)(8) the defendant is hereby
ordered to transfer all firearms in his/her possession and the defendant’s concealed handgun
permit is hereby suspended.
C.Cr.P. Art 1000 “Firearm” means any pistol, revolver, rifle, shotgun, machine gun, submachine gun, black
powder weapon, or assault rifle which is designed to fire or is capable of firing a fixed cartridge ammunition
or from which a shot or projectile is discharged by an explosive.

1. Do you have a concealed handgun permit Yes______No_______ If yes permit #_____________
2. Do you have possession of firearm(s)
No______ [If no continue to statement of defendant.]
Yes______ [If Yes, continue to question 3.]

3. Firearm(s) Information
Number of
Type of Each Firearm
Firearms

Location of Each Firearm

The defendant shall transfer any and all firearm(s) in his/ her possession, control or custody
including, but not limited to the firearm(s) described above. The defendant shall transfer all of
his/ her firearm(s) within 48hrs of the issuance of this order. If defendant is in custody the transfer
must be within 48hrs from the time of release. The defendant shall within 10 days of transferring
firearm(s) file the Proof of Transfer form with the clerk of court of the parish in which the order
was issued. If the defendant possesses a concealed handgun permit, the concealed handgun
permit is hereby suspended.
Is defendant in custody at the time of the issuance of this order?
Date of order

______/______/______
Month/ day/ year

Date of release

____/______/______
Month/ day/ year

YES_________NO__________

Time of order

______________am/pm

SIGNATURE OF JUDGE

Time of release

______________am/pm

SIGNATURE OF RELEASING OFFICIAL

STATEMENT BY DEFENDANT: I HAVE READ THIS ORDER AND I understand that if I violate this order
by failing to transfer my firearm(s) in a timely manner, I can be arrested and punished for contempt of court.
I also understand that if I am in possession of a concealed handgun permit this permit is hereby suspended.
___________________________________

____________________________

Signature of Defendant

Date/ Time