....... Respondent

UPON HEARING AN APPLICATION made to this Court to-day by the above- named applicant, of ....... a Chief Superintendent of the Garda Síochána for the locality in which a collection was held, namely, ......... in court area and district aforesaid, pursuant to a collection permit granted under the provisions of the above Act to the above-named respondent, of ...........

FOR AN ORDER pursuant to section 23 (1) of the above Act,

THE COURT being satisfied

1. that the application is made within six months after the day, or the last of the days, on which the said collection was made,

2. that not less than forty-eight hours before the hearing of the application the Applicant served notice of application upon the respondent,

*(3. that it is in the public interest to make this order,)

*[and having heard ........, a member of the Garda Síochána not below the rank of Inspector, state on oath that s/he has reasonable grounds for believing that * (portion of) the proceeds of the collection *have been/*are being/ *will be used-

*(i) for the benefit of an object which is *unlawful/ *contrary to public morality, (or) for the benefit of an organisation membership of which is unlawful,

*(ii) in such a manner as to encourage either directly or indirectly the commission of an unlawful act,]

HEREBY DIRECTS THE RESPONDENT

to furnish to the applicant, not more than one month after the date of this order, a statement in writing showing the total amount collected by means of the collection and how the money so collected was applied and disposed of,

to permit the applicant or any member or members of the Garda Síochána designated by the applicant to inspect any accounts kept by the respondent and any receipts or other vouchers relating to the collection.

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

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

Judge of the District Court.

* Delete where inapplicable