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, * RETURN ON

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vs. * SEARCH WARRANT

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, *

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Defendant. *

* * * * * * * * * * * * * * * *

On the day of , 19 , by authority of the attached Search Warrant, I searched the premises described as follows: .

The following list of items were seized during the course of this search as authorized by the Search Warrant: .

This list is full and complete and contains every item seized by me during this search.

DATED this day of , 19 .

Title

Subscribed and sworn to before me this day of

, 19 .

Justice of the Peace