District No.

THE INFORMATION of ......, a member of the Garda Síochána of ..............

who says on oath:—

I believe that a certain person, namely, ......... has in his/her custody or under his/her control or on his/her premises at ..........., in the said court district, a certain thing, namely, .......... and, that it has been used, or is intended for use, without lawful excuse,

*(to damage property, namely, ............ belonging to another,)

*(to damage property, namely, ............. in a way likely to endanger the life of another or with intent to defraud,)

*(to access, or with intent to access, data,)

The basis for such belief is as follows:—

and I hereby apply for the issue of a search warrant in respect of the said premises under section 13 (2) of the Criminal Damage Act, 1991.

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

Informant

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

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

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

Judge of the District Court

*Delete clauses which do not apply.