O.34A, r. 2(4)

District No.

The information of ................. of the Revenue Commissioners, ................., who says on Oath—

1. I am an Officer of the Revenue Commissioners not below the rank of Principal Officer, and a Superior Officer within the meaning of section 1 of the Criminal Justice (Surveillance) Act 2009, which I hereinafter refer to as “the Act”.

2. An Authorisation was issued to me by Judge.................of the District Court at ................... on the....day of .......... 20... pursuant to section 5 of the above-mentioned Act for the carrying out of surveillance

(a) by the use of a surveillance device the particulars of the same being

(b) *the person who was to be the subject of the surveillance being

*the place to be the subject of the surveillance being

........................

*the thing to be the subject of the surveillance being

........................

(c) the Superior Officer to whom the Authorisation was issued being me the informant

*(d) the conditions imposed in respect of the surveillance authorised being

(e) the date of expiry of the surveillance being the ..... day of .......... 20 ...

*me, the Superior Officer, * .............. of .............. an officer of the Revenue Commissioners designated by me, the Superior Officer, accompanied by any other person whom *I/*he/*she considered necessary, to enter, if necessary by the use of reasonable force, any place for the purpose of initiating or carrying out the authorised surveillance, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the place.

*3. The said Authorisation was renewed by Judge ........... of the District Court at ............ on the .... day of .......... 20....

4. The said Authorisation will expire on the ..... day of ....... 20.....

5. *I believe that the variation of the said Authorisation in the following terms is justified ........................

*I believe that the *(further) renewal of the said Authorisation *on the same conditions *on different conditions, namely, that .................... for a further period of ................... is justified.

My grounds for so believing I set out in this my information hereunder.

†6. The Revenue Commissioners are continuing to carry out an operation or investigation concerning a revenue offence *contrary to *under

*section 186 of the Customs Consolidation Act 1876

*section 1078 of the Taxes Consolidation Act 1997

*section 102 of the Finance Act 1999

*section 119 of the Finance Act 2001

*section 79 (inserted by section 62 of the Finance Act 2005) of the Finance Act 2003

*section 78 of the Finance Act 2005, namely

........................

(here specify the offence in question)

*I believe that the *variation *renewal of the Authorisation to carry out surveillance being sought to be authorised, as part of the said operation or investigation, is necessary for the purposes of obtaining information as to whether the offence has been committed. I give details of the grounds I have for so believing in this my information hereunder.

*I believe that the *variation *renewal of the Authorisation to carry out surveillance being sought to be authorised, as part of the said operation or investigation, is necessary for the purposes of obtaining information as to the circumstances relating to the commission of the offence. I give details of the grounds for so believing in this my information hereunder.

*I believe that the *variation *renewal of the Authorisation to carry out surveillance being sought to be authorised, as part of the said operation or investigation, is necessary for the purposes of obtaining evidence for the purposes of proceedings in relation to the offence. I give details of the grounds I have for so believing in this my information hereunder.

†6. I believe that the surveillance being sought to be authorised is necessary for the purposes of preventing the commission of revenue offences. I give details of the grounds I have for so believing in this my information hereunder.

7. I believe that the *variation *renewal of the Authorisation to carry out surveillance being sought would involve surveillance which is

(a) the least intrusive means available, having regard to the objectives and other relevant considerations,

(b) proportionate to its objectives, having regard to all the circumstances including its likely impact on the rights of any person, and

(c) of a duration that is reasonably required to achieve its objectives.

*8. I believe that, if the *variation *renewal of the Authorisation to carry out surveillance being sought is granted, it will *(continue to) be necessary for the Revenue Commissioners to enter, if necessary by the use of reasonable force, a place, namely ..............., for the purposes of initiating or carrying out the surveillance to be authorised, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the said place.

9. The period during which the surveillance on foot of the *variation *renewal of the Authorisation to carry out surveillance is intended to be carried out is from the ...... day of ........ 20.... to the ...... day of .......... 20....

I say further and give the following information:

10. Details of the surveillance device intended to be used pursuant to the variation of the Authorisation to carry out surveillance being sought

........................

†11. *My grounds for believing that the *variation *renewal of the Authorisation to carry out surveillance being sought is necessary for the purposes of obtaining information as to whether the offence hereinbefore referred to has been committed are:—

........................

*My grounds for believing that the *variation *renewal of the Authorisation to carry out surveillance being sought is necessary for the purposes of obtaining information as to the circumstances relating to the commission of the offence hereinbefore referred to are:—

........................

*My grounds for believing that the *variation *renewal of the Authorisation to carry out surveillance being sought is necessary for the purposes of obtaining evidence for the purposes of proceedings in relation to the offence hereinbefore referred to are:—

........................

†11. My grounds for believing that *variation *renewal of the Authorisation to carry out surveillance being sought is necessary for the purpose of preventing the commission of revenue offences are:—

........................

12. My grounds for believing that the *variation *renewal of the Authorisation to carry out surveillance being sought would involve the least intrusive means available having regard to the objectives and to other relevant circumstances are:—

........................

13. My grounds for believing that the *variation *renewal of the Authorisation to carry out surveillance being sought is proportionate to its objectives having regard to all the circumstances and its likely impact on the rights of any person are:—

........................

14. My grounds for believing that the duration of the *variation *renewal of the Authorisation to carry out surveillance being sought is reasonably required to achieve its objectives are:—

........................

*15. My grounds for believing that, if the *variation *renewal of the Authorisation to carry out surveillance being sought is granted, it will *(continue to) be necessary for the Revenue Commissioners to enter, if necessary by the use of reasonable force, a place, namely ............, for the purposes of initiating or carrying out the surveillance to be authorised, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the said place, are:— ........................

AND I hereby apply for

*a variation under section 6(1)(a) of the Act of the said Authorisation to carry out surveillance under section 5 of the Act on the terms and conditions set out above for the period of .............. from the .... day of ................ 20 .... to the ..... day of ........... 20 ... (being a period not exceeding three months)

*a renewal under section 6(1)(b) of the Act of the said Authorisation to carry out surveillance under section 5 of the Act on the terms and conditions set out above for the period of .............. from the ..... day of ........... 20 ... to the .... day of .......... 20.... (being a period not exceeding three months)

*AND that the Authorisation as so *varied *continued should authorise *me as the Superior Officer so authorised/*an officer of the Revenue Commissioners designated by me as the Superior Officer so authorised, accompanied by any other person whom *I consider/*said officer considers necessary, to enter, if necessary by the use of reasonable force, the said place for the purposes of initiating or carrying out the authorised surveillance, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the said place.

Signed: ........................

Informant

SWORN before me this ...... day of .......... 20...

Signed: ...........................

Judge of the District Court

* Delete any words or paragraphs which are inapplicable, including any options which do not apply to the case.

† One of the alternatives for this paragraph must be included.