District No.

WHEREAS from the information on oath and in writing sworn before me on this day pursuant to section 14 of the above-mentioned Act by ........... of .................., a member of the Garda Síochána,

I AM SATISFIED THAT there is reasonable ground for believing that an offence under section 9 or 10 of the said Act is taking or has taken place in the place .................... in the court (area and) district aforesaid,

THIS IS TO AUTHORISE YOU, ................... of ............., the said member of the Garda Síochána accompanied and assisted in the exercise of the powers hereby conferred on you by any one or more of the following, namely, any member of the Garda Síochána or any person authorised by you, TO ENTER, and if need be by force, the said ................ in the court (area and) district aforesaid, and there TO SEARCH FOR equipment to which section 9 (1) (c) or 9 (2) (a) of the said Act relates and TO EXAMINE all such equipment there found and TO SEIZE AND TAKE AWAY all or any part of such equipment.

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

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

Judge of the District Court

To the Superintendent of the Garda Síochána,

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