Name

County Attorney

Address

City, State, Zip

Telephone Number

Attorney for Plaintiff

MONTANA JUDICIAL DISTRICT COURT, COUNTY

*

STATE OF MONTANA, * CAUSE NO.

*

Plaintiff, * JUDGE

*

vs. * RECEIPT FOR

*

VEHICLE and , * PROPERTY SEIZED

*

Defendant. *

* * * * * * * * * * * * * * * * I, , hereby certify that on the day of , 19 , by authority of an order of seizure, a copy of which is attached, have seized the following property pursuant to said order:

1.

2.

3.

This is a full and complete list of every item seized by me.

DATED this day of , 19 .

Title

ACKNOWLEDGMENT

I, , hereby certify that on this day of , 19 , I received a copy of the foregoing Receipt for Property Seized.

Defendant