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CC-1395A

Protective Order – Act of Violence Conviction Firearm Certification

Virginia · Supreme Court of Virginia

This form is a certification that a person named as the Respondent must file after a Protective Order related to an Act of Violence Conviction. It asks the Respondent to confirm whether they possess any firearms or to list where they have surrendered, sold, or transferred all their firearms.

Open the official PDFfrom Supreme Court of Virginia

Where this fits in a case

Judgment

Stage: Judgment

This form is used by the Respondent after a Protective Order has been entered by the court. The form requires the Respondent to certify their compliance with firearm rules set by the Protective Order.

Usually filed by the person responding.

Official instructions

How-to guides published by the court for this form.

Common questions

Who must fill out this form?
The named Respondent must complete and file this certification form with the clerk of the court that entered the Protective Order.
What must I do after signing this form?
The form states that the Respondent must file this completed certification form with the clerk of the court within 48 hours after being served with the Protective Order.
What does the form say about firearms?
The form includes a section where the Respondent certifies if they have firearms or where they have transferred them, and it notes that the Respondent cannot purchase, transport, or possess any firearm while the Protective Order is active.

Revision history

No changes recorded since we started tracking this form on October 10, 2026.

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