Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

To a judge of the court from which the warrant was issued (specify court):

I, (name of the peace officer or other person) have acted under a warrant issued under section 462.32 of the Criminal Code and have

• 1 searched the premises situated at ; and

• 2 seized the following property:

  Property Seized (describe each item of property seized)	Location (state, in respect of each item of property seized, the location where it is being detained).
  1.
  2.
  3.
  4.

Dated this day of A.D. , at .

Signature of peace officer or other person