District No.

THE INFORMATION of .........., of ...........,

who says on oath—

1. I am a member of the Garda Síochána not below the rank of sergeant.

2. I believe that there are reasonable grounds for suspecting that a *script *recording referred to in section 3 (8) of the above-mentioned Act is *[in the premises (within the meaning of section 9 (3) of the said Act) that is to say, in the ..........] *(at a place, that is to say, .........) at, ............ in the court (area and) district aforesaid.

3. The basis for my so believing is as follows:—

*[4. I say that on the day of 19 , on the authority of an order in writing made by Superintendent ....... of the Garda Síochána under section 3 (8) (a) of the said Act, I required one, ............., under subparagraph (I) of the said section 3 (8) (a) to produce, if such a thing existed, a *script *recording referred to in section 3 (8) of the said Act,

(a) and that such requirement was not complied with

(b) and that when the *script *recording was produced to me I required that person, under subparagraph (II) of the said section 3 (8) (a), to afford me an opportunity of causing a copy thereof to be made, and that such latter requirement was not complied with.]

*[5. I say that a requirement specified in *(subparagraph (I)) *(subparagraph (II)) of section 3 (8) (a) of the said Act was not made in relation to the said *script *recording for the following reason(s):—

.]

6. I hereby apply for the issue of a warrant under section 9 of the said Act in respect of the said *premises *place.

Signed ...................

Informant

SWORN before me this ... day of ....... 19 .....

at ...................

Signed .................

Judge of the District Court

(or) Peace Commissioner

*Delete where inapplicable.