District No.

......... Applicant of ............

*(in court area and district aforesaid)

and

......... Respondent of ..............

WHEREAS the following property has come into the possession of the Garda Síochána at .......... in the said district *(in connection with a criminal charge),

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

TAKE NOTICE that the above-named applicant, being

*a superintendent of the Garda Síochána,

*a claimant of the said property,

will apply at the sitting of the District Court to be held at ......... on the ... day of ...... 19 at a.m./p.m. pursuant to section 1 (1) of the above-mentioned Act for an order for the delivery of the said property to the owner thereof or such order with respect to the property as to the Court may seem meet.

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

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

Applicant/Solicitor for Applicant

To

of

the above-named respondent.

* Delete words inapplicable