District No.

BEING SATISFIED from the application made, by information on oath and in writing sworn before me on this day, by the under-named member of the Garda Síochána for the issue of a search warrant under section 13 (2) of the above-mentioned Act, that there is reasonable cause to believe that a person has in his/her custody or under his/her control or on his/he under-mentioned premises a certain thing, namely, ........... and that it has been used, or is intended for use, without lawful excuse,

*(to damage property (other than data), namely,.......... belonging to another,)

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

I HEREBY AUTHORISE ..........., a member of the Garda Síochána, of .........., accompanied by such other members of the Garda Síochána as may be necessary, at any time or times within one month of the date hereof, TO ENTER, if need be by force, the premises situated at ........... in the said court district, TO SEARCH the premises and any persons found therein, and TO SEIZE AND DETAIN anything which he/she believes to have been used or to be intended for use as aforesaid.

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

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

Judge of the District Court

To Superintendent of the Garda Síochána,

at

*Delete clause which does not apply