IN THE JUSTICE COURT OF COUNTY, STATE OF MONTANA

BEFORE , JUSTICE OF THE PEACE

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STATE OF MONTANA, * CAUSE NO.

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Plaintiff, * RECEIPT ON

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vs. * SEARCH WARRANT

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, *

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Defendant. *

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I, , by authority of a search warrant, a copy of which is attached, have search the premises described therein and have seized the following items of personal property: .

A copy of this receipt, and a duplicate copy of the Warrant have been left with at the above-stated premises.

DATED this day of , 19 .

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