WR NICS Index Mental Submission Check List Lo Tafemetion Hervices Diviaboa’ ‘Seca) seectan eh seta vaneah deehibition Hie ad 8 provide the following sastact information, type ox print Zopibly: Howy Pam cy HOS pirat fc onney ef ndivicent® knee peonibiced feon puschenina fisemns 1 eovide whe t0% Crininal Susctee ¢ reuse chuck System te wide Sea lapency ate De ry bre Per Fer Fax tuber: Lense prowias ere a ppecigeive informacion, type oF print tegibay e spotens tasn) Deve of Birtni+ Sex: Abies tenes: Sadesce: bé -3 Per FBX ace: 4 Sauurisy Ynke bic ~3 Ber FRI anf weisne] piace of sixes ato of Residency: yorkie your entey under one of the following: (27 mnvolentariiy Commitend for Treatment sPlaase sapproxinate a of comnitecct: Sigua bagud vo Agency Hane: Wour Baye). 110s D Adjudicated as a vantal Defective sFleass provige docune ‘from the co suchority. Checkxark vide the nane of he ngeitution, court, or Lawful autporizy and che Spi le ep i on eh ae ha ven DOS BIN lh hr fos othe! board, comsiset adjudication: Die a danger to hinsolf oF te Backs the mental cupec: DA person who is found A pecan who 19 found Ani Anaane by a court in a criminal atone to aeand trial or found not guilty by 0 Coda oF Kilitacy duetice Stgnatuse and a yey signature: _| ~ —— isto! aa: tome end any addttionat documentation to thw NICB Section ab the following: NICS_Index_Submissious-External@fbi For questions, plesie cai (206) €25-7834 or (304) €25-7399. acs cin 980 hres KOH. gov be -4 Per Er bic -4 Per Fer 20-cv-206(FB1)-338 ese i018 88 Wid 98064 ShoesLzes