Form 5.3

FORM 5.3 (Section 462.32)

Report to a Judge of Property Seized

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).

Dated this  day of  A.D.  , at  .

Signature of peace officer or other person