Memphis Police Department Firearm Release Request Form

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FRR_PAGE 1 of 2
MEMPHIS POLICE DEPARTMENT
201 Poplar Avenue, Memphis, TN 38103
Office: (901) 636-3716 E-Mail: MPD.LegalOffice@MemphisTN.gov
FIREARM RELEASE REQUEST FORM
DISCLAIMER: This form is to be used only by the owner of a firearm which is in the custody or control of the Memphis
Police Department’s Property and Evidence Unit in an attempt to redeem the firearm. This form exists only as an official
claim of said property and may not be used to transfer a firearm or to prove ownership of a firearm. Submission of this
form does not guarantee eligibility to retrieve property being held with the Memphis Police Department.
(Please refer to page 2 of 2 for additional information.)
A. Applicant Information
Last Name:
First Name:
Middle Initial:
Suffix:
Address:
City:
State:
Zip Code:
Date of Birth (MM/DD/YYYY):
Social Security Number:
Race:
Sex:
Driver License Number:
Home Phone Number (Include Area Code):
Mobile Phone Number (Include Area Code):
E-mail Address:
B. Case and Firearm(s) Information
(Please refer to page 2, part B before completing this section)
Incident Report Number (10 digits, ending in ‘ME’):
Property Receipt Number:
Check all that apply:
Make:
Model:
Serial Number:
Reported as Missing or Stolen
Make:
Model:
Serial Number:
NOT Reported as Missing or Stolen
Make:
Model:
Serial Number:
Applicant is Beneficiary or Attorney
Ship weapon to Law Enforcement Agency? Yes ______
No______
C. Declaration
I declare under penalty of perjury under the laws of the State of Tennessee that the foregoing is true and correct and that I am the lawful owner or
legal beneficiary of all firearms that I seek to have returned. I expressly authorize the Memphis Police Department to perform firearms eligibility
checks of all relevant state and federal databases, including the Federal Bureau of Investigation’s National Instant Criminal Background Check
System. I also understand that if I currently possess or own firearms and the results of this check reveal that I am ineligible either to lawfully
possess or purchase firearms, I must relinquish any and all firearms in my possession.
Signature: _______________________________________________________
Date: _____________________________________
OFFICE USE ONLY
Proof of Ownership Included w/Application
Proof of Ownership NOT Included w/Application
Case Reflects Pending Court Disposition
Date Received:
Date Processed:
Processed by (Last Name and IBM#):
Stamp Approved or Denied Here
Officer Assigned (Last Name and IBM#):
Precinct:
Date Submitted:
Date Returned:
Location ID:

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