Affidavit Upon Receipt of Firearms

Making a sworn statement by an affiant that he/she has received the firearms and/or other weapons related to the defendant, the following affidavit has to be executed.

Extracted Text for Proper Search

Form152A Affidavit Upon Receipt of Firearms (10/2014)      
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            STATE OF VERMONT
  
SUPERIOR COURT  FAMILY DIVISION 
  Unit  Docket No. 
  Plaintiff   Name   DOB     Defendant   Name   DOB  
    v .      
 
AFFIDAVIT UPON RECEIPT OF FIREARMS 
Subject to the penalties for perjury, I state the following facts to be true to the best of my knowledge and belief.   
Please remember to be specific:   
1. I have received the following firearms, ammunition and/or weapons belonging to: 
____________________________________ 
Defendant’s Name 
  (list all of the firearms, ammunition and/or other weapons that you have received with a specific description of 
each.)  
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Form152A Affidavit Upon Receipt of Firearms (10/2014)      
                                                                                                                                    Page 2 of 2 
           
2.
  I will be responsible for the secure storage of the se firearms, ammunition and/or other weapons and I 
will not allow the defendant  to obtain possession of them without a court order . 
 
3  I will store all of the above described firearms, ammunition and/or weapons in a secure manner as  follows: ( describe specifically the arrangements you have m ade for the storage of the weapons.)  
 
 
 
 
 
 
 
 
 
 
 
   
4.   I am not prohibited from owning or possessing firearms by either State or Federal law. 
 
5.   I understand the obligations and requirements of the Relief from Abuse Order issued in this case.  I 
specifically understand that I may personally be subject to civil contempt proceedings if: 
a.  I violate the terms of the commitments I have made in this affidavit; 
b.  I permit the Defendant to possess, access or use the firearms, ammunition and/or other weapons 
that the Court has ordered me to securely store;  or 
c.   I permit any unauthorized person to possess, access or use the firearms, ammunition and/or other 
weapons that the Court has ordered me to securely store. 
 
 
 
   
 
 
WARNING 
MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A 
FINE, OR BOTH AS PROVIDED BY 13 V.S.A. §2904.  I hereby swear or affirm that the information above is  true to the best of my knowledge and belief.  
 
 
  Signature   
 
  Date  
 
Printed Name  
 
 
Street Address  
 
 
City/Town/State and Zip Code  
 
 
Signed and sworn before me:  
Date  
 
  Signature of Notary Public   Expiration Date