Appendix I: State Police Gun Control Notification
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COMMONWEALTH OF PENNSYLVANIA |
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| The Uniform Firearm Act, 18 PA. C.S. 6105 (c)(4) specifies that it shall be unlawful for any person adjudicated as an incompetent or who has been involuntarily committed to a mental institution for inpatient care and treatment under Section 302, 303, or 304 of the Mental Health Procedures Act of July 9, 1976 (P.L. 817, No. 143) to possess, use, manufacture, control, sell or transfer firearms. This would include adjudication of incapacity pursuant to 20 Pa.C.S.A. §5501. Pursuant to the Pennsylvania Mental Health Procedures Act, Section 109, notification shall be transmitted to the Pennsylvania State Police by the judge, mental health review officer or county mental health and mental retardation administrator within SEVEN days of the adjudication, commitment or treatment by first class mail to the Pennsylvania State Police, Attention: Firearm Unit, 1800 Elmerton Avenue, Harrisburg, PA 17110. NOTE: The envelope shall be marked "CONFIDENTIAL." | |
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Place an "X" on either Involuntary Commitment or Adjudicated Incompetent |
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| INVOLUNTARY COMMITMENT | ADJUDICATED INCOMPETENT |
| Date of Involuntary Commitment or Adjudicated Incompetent | |
| INDIVIDUAL INFORMATION (INDIVIDUAL
INVOLUNTARILY COMMITTED OR ADJUDICATED INCOMPETENT) LAST NAME FIRST MIDDLE JR., ETC. MAIDEN NAME ALIAS DATE OF BIRTH SOCIAL SECURITY NUMBER SEX RACE HEIGHT WEIGHT HAIR EYES ADDRESS |
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| NOTIFICATION BY (Please
print name, address, area code, and phone number of agency or county court.) County Submitting Notification County Mental Health and Mental Retardation
Administrator
County Mental Health Review Officer
Physician Certifying Necessity of Involuntary Commitment
Hospital / Facility Providing Treatment / Address Judge
SIGNATURE OF NOTIFYING OFFICIAL DATE Court Case Number
Date of Court Order |
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NOTIFICATION OF PHYSICIAN'S DETERMINATION THAT NO SEVERE MENTAL DISABILITY EXISTS |
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| The physician shall provide signed confirmation
of the determination of the lack of severe mental disability following the
initial examination under Section 302(b) of the Mental Health Procedures
Act and pursuant to the Uniform Firearms Act, Section 6111.1 (g)(3).
Notice shall be transmitted by the physician to the Pennsylvania State
Police through the county mental health and mental retardation
administrator or mental health review officer. Name of Physician (Please print.) Signature of Physician Date |
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