Chester County Department of Emergency Services CLEAN/NCIC Form

Gun Entry/Confiscated/Seized

Agency

Officer Name

Phone Number

Report Type

Gun Entry Type

Was the gun seized or confiscated from an individual?

Yes

Municipality of Incident

County Event #

Date of Theft or Loss

Date of Recovery

Report Date

Gun Make

Other Gun Make

Gun Model

Weapon Type

Caliber

Serial Number

Miscellaneous Info/Comments (barrel length, color, inscriptions, etc.)

Complete this section if gun seized or confiscated from an individual.

Individual's Name (first, middle, last)

Date of Birth

OLN #

State

Was gun possessed by a prohibited person (PPP)?

Yes

Arrest Made (ARM)

Yes

Permit in LTC (LTC)?

Yes

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