District No.

........... Prosecutor

........... Offender

WHEREAS it appears from an information in writing sworn on the ... day of .... 19... by ........... of ........... that the above-named ....... of .......... having entered into a recognisance *(with a surety/sureties) before the Court on the ... day of ..... 19.. pursuant to section 28 (2) (a) of the Misuse of Drugs Act, 1977 conditioned that he/she

*(a) would be under the supervision of ........ during the period of ......... from the date of the recognisance, and would receive visits from and permit visits by the said .......... *(at the Principal Party's residence) *(at ......... ) as follows:-

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

*(b) would undergo medical or other treatment recommended in the report made by ................

*(c) would, for the treatment referred to at condition (b) above, *(attend) *(remain) in the hospital, clinic or other place at ......... for the period of ...........

*(d) would attend the following course of education, instruction or training:

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

did fail to observe the said condition(s) in that he/she failed to-

THIS IS TO COMMAND YOU to whom this warrant is addressed to arrest the said ......... of ...... and to bring him/her before me or some other Judge to be dealt with according to law.

Dated this .... day of ...... 19 ....

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

Judge of the District Court.

To the Superintendent of the Garda Síochána,

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

*Delete where inapplicable