Province of ,
To the justice who issued a warrant to the undersigned pursuant to section 256, 487 or 487.1 of the Criminal Code (or another justice for the same territorial division or, if no warrant was issued, any justice having jurisdiction in respect of the matter).
I, (name of the peace officer or other person) have (state here whether you have acted under a warrant issued pursuant to section 256, 487 or 487.1 of theCriminal Codeor under section 489 of theCriminal Codeor otherwise in the execution of duties under theCriminal Codeor other Act of Parliament to be specified)
1 searched the premises situated at ; and
2 seized the following things and dealt with them as follows:
(describe each thing seized)
(state, in respect of each thing seized, whether
1. 2. 3. 4.
In the case of a warrant issued by telephone or other means of telecommunication, the statements referred to in subsection 487.1(9) of the Criminal Code shall be specified in the report.
Dated this day of A.D. , at .
Signature of peace officer or other person
- R.S., 1985, c. 27 (1st Supp.), s. 184
- Date modified: