......... Respondent

TAKE NOTICE that 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 to you, the above-named respondent, INTENDS TO APPLY at a sitting of the District Court to be held at ......... on the ... day of ..... 19.. at ... a.m./p.m. for an order under section 23 (1) of the above Act directing you (1) to furnish to the applicant 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;

(2) to permit the applicant or any member or members of the Garda Síochána designated by him/her to inspect any accounts kept by you and any receipts or other vouchers relating to the collection.

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

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

Applicant.

To

of

the above-named respondent.