Affidavit - Proof Of Transfer Of Firearms {CRM-610}

THIS DOCUMENT SHALL BE SEALED UPON FILING WITH THE COURT State of Minnesota County Judicial District: Court File Number: Case Type: District Court Criminal State of Minnesota Plaintiff Affidavit / Proof of Transfer of Firearms vs Defendant STATE OF MINNESOTA COUNTY OF I, ) ) SS ) , state the following: , the Defendant named above (Date firearms were transferred/received) On the following law enforcement agency: __________________________________, (name of agency) permanently or temporarily transferred the firearms identified below to me (check one box below): a person who may lawfully receive firearms and does not live with the Defendant. acknowledge that I may be held criminally and civilly responsible under Minn. Stat. § 624.7144 if the Defendant named above gains access to a transferred firearm while the firearm is in my custody. I a law enforcement agent with the following agency __________________________. a federally licensed firearms dealer, FFL# . CRM610 State ENG Rev 7/15 www.mncourt.gov/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com THIS DOCUMENT SHALL BE SEALED UPON FILING WITH THE COURT List the name, make, model and caliber of all firearms transferred in the table below: Firearm Name / Make 1. 2. 3. 4. 5. 6. 7. Serial Number Model / Caliber If the Defendant transferred the firearms, the Defendant must file this Affidavit/Proof of Transfer with the court within two business days of the firearm transfer. If a law enforcement agency transferred the firearms, the law enforcement agency transferring the firearms must file this Affidavit/Proof of Transfer with the court within two business days of the firearm transfer. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: ________________________________ Signature Name Agency or Business Name, if applicable: Address City/State/Zip Telephone ( E-mail address: ) CRM610 State ENG Rev 7/15 www.mncourt.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com